探讨基于动脉穿支的双叶皮瓣在不同部位4期压疮治疗中的修复效果。

选择2021年8月至2023年3月徐州市第一人民医院烧伤整形及创面修复科收治的25例符合入选标准的4期压疮患者，其中男19例，女6例，年龄12~82岁。坐骨结节压疮11例，利用基于股深动脉第1穿支的股后双叶皮瓣进行修复。骶尾部压疮14例，其中13例利用基于臀上动脉穿支的双叶皮瓣进行修复，1例利用基于臀下动脉穿支的双叶皮瓣进行修复。术后观察愈合效果及随访情况。

25例双叶皮瓣均无需切断蒂部皮肤和皮下组织，也不需要分离穿支血管，均可达到良好的旋转及覆盖效果。23例皮瓣一期愈合，术后2周顺利拆线；2例皮瓣因术后受压导致局部切口裂开及皮缘发黑坏死，经清创换药治疗2周后愈合。术后随访1~18个月，所有患者压疮无复发，皮瓣均成活良好，质地柔软、弹性好、血运良好，术区仅遗留线性瘢痕。

基于股深动脉第1穿支的股后双叶皮瓣及基于臀上/臀下动脉穿支的双叶皮瓣，方法简单可靠，在不同部位4期压疮的治疗中临床效果良好，对于老年患者可以作为修复坐骨结节及骶尾部4期压疮的理想皮瓣方案。

To explore the clinical application effect of bilobed flap based on artery perforator in the treatment of stage 4 pressure sores at different sites.

From August 2021 to March 2023, 25 patients with stage 4 pressure sores in the First People's Hospital of Xuzhou met the inclusion criteria were included in this study, including 19 males and 6 females aged 12 to 82 years. 11 patients suffered stage 4 pressure sores in ischial tuberosity and were repaired with a posterior femoral bilobed flap based on the first perforating branch of deep femoral artery. 14 patients developed stage 4 pressure sores in the sacrococcygeal region, of which 13 cases were treated with a bilobed flap based on the perforating branch of the superior gluteal artery, and the other one was treated with a bilobed flap based on the perforating branch of the inferior gluteal artery. The survivals of flaps and appearances of donor sites were followed up.

All the 25 cases of bilobed flap did not need to cut off the pedicle skin and subcutaneous tissue, nor separate the perforator vessels, which can rotate well and cover the wound effectively. Flaps of 23 patients survived well and sutures were removed 2 weeks after operation. Local incision dehiscence and skin margin blackened and became necrotic due to post-operative compression in 2 cases, and healed after 2 weeks of debridement and dressing change. The follow-up period was 1~18 months. The results of follow-up showed that all the 25 pressure sores healed well without recurrence, and flaps survived with good elasticity, blood circulation, and soft texture. Only linear scar was left in the donor area.

The posterior femoral bilobed flap based on the first perforating branch of the deep femoral artery and the bilobed flap based on the perforating branch of the superior/inferior gluteal artery are simple and reliable, and have a good clinical effect in the treatment of stage 4 pressure sores at different sites. For the elderly patients with stage 4 pressure sores in the ischial tubercle and sacrococcygeal region, it can be used as an ideal flap scheme.