Couple-kissing flaps for successful repair of severe sacral pressure ulcers in frail elderly patients

Zhao, Jichun; Zhang, Boru; Shi, Kai; Yu, Jun; Wang, Jian; Yu, Qinghua; Liu, Hong

doi:10.1186/s12877-017-0680-4

Cited by 8 publications

(8 citation statements)

References 29 publications

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“…PU are chronic lesions, localized injuries to the skin and underlying soft tissue caused by pressure, shear, friction, or a combination of these, often present in patients with limited mobility or sensory perception and paralyzed or unconscious patients who can neither sense nor reply to the intermittent need for changing the position ( Dam et al, 2011 ; Zhao et al, 2016 ; Zhao et al, 2017 ; Mervis and Phillips, 2019 ). Although many advanced therapies are available for chronic wounds, such as growth factor-based therapies, negative pressure, oxygen, shock wave, and photobiomodulation therapies, each therapy presents limited benefits, and clinical outcomes vary among patients ( Han and Ceilley, 2017 ; Jones et al, 2018 ; Oliveira et al, 2020 ).…”

Section: Discussionmentioning

confidence: 99%

Single-cell analysis reveals melanocytes may promote inflammation in chronic wounds through cathepsin G

et al. 2023

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During acute wound (AW) healing, a series of proper communications will occur between different epidermal cells at precise temporal stages to restore the integrity of the skin. However, it is still unclear what variation happened in epidermal cell interaction in the chronic wound environment. To provide new insights into chronic wound healing, we reconstructed the variations in the epidermal cell-cell communication network that occur in chronic wound healing via single-cell RNA-seq (scRNA-seq) data analysis. We found that the intricate cellular and molecular interactions increased in pressure ulcer (PU) compared to AW, especially the PARs signaling pathways were significantly upregulated. It shows that the PARs signaling pathways’ main source was melanocytes and the CTSG-F2RL1 ligand-receptor pairs were its main contributor. Cathepsin G (CatG or CTSG) is a serine protease mainly with trypsin- and chymotrypsin-like specificity. It is synthesized and secreted by some immune or non-immune cells. Whereas, it has not been reported that melanocytes can synthesize and secrete the CTSG. F2R Like Trypsin Receptor 1 (F2RL1) is a member of proteinase-activated receptors (PARs) that are irreversibly activated by proteolytic cleavage and its stimulation can promote inflammation and inflammatory cell infiltration. In this study, we found that melanocytes increased in pressure ulcers, melanocytes can synthesize and secrete the CTSG and may promote inflammation in chronic wounds through CTSG-F2RL1 pairs, which may be a novel potential target and a therapeutic strategy in the treatment of chronic wounds.

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Section: Discussionmentioning

confidence: 99%

Single-cell analysis reveals melanocytes may promote inflammation in chronic wounds through cathepsin G

et al. 2023

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“…The application of air-fluidized supports showed beneficial effects in patients that meet immobility as a risk factor of the LIGhT criteria and may therefore justify the disadvantages of being costly and inconvenient. 16,[25][26][27][28][29] According to the applied regression model, wound surface was the second strongest predictor of surgical outcome within the investigated variables (OR, 7.3; 95 percent CI, 2.7 to 19.9) (Table 3). This suggests that wound surface is a key metric for determining the extent and complexity of an operative procedure.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

“A-PePSI LIGhT” Assessment Score to Predict Pressure Sore Impaired Healing Late Recurrence, Immobility, Greater Surface, Inhibited Thrombocytes

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Ruewe

Prantl

et al. 2021

Plastic &Amp; Reconstructive Surgery

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Background: Complication rates of up to 46 percent are reported following pressure sore surgery. Pressure sore patients often exhibit ineffective postoperative wound healing despite tension-free flap coverage, necessitating surgical revision and prolonged hospitalization. Rather than pressure sore recurrence, such impaired healing reflects a failed progress through the physiologic stages of the normal wound-healing cascade. The principal objective of the study reported here was to elucidate potentially modifiable inherent variables that predict predisposition to impaired healing and to provide a tool for identifying cases at risk for complicated early postoperative recovery following pressure sore reconstruction. Methods: A retrospective chart review of late-stage (stage 3 or higher) sacral and ischial pressure sore patients who underwent flap reconstruction from 2014 to 2019 was performed. A multivariable logistic regression model was used to identify key patient and operative factors predictive of impaired healing. Furthermore, the Assessment Score to Predict Pressure Sore Impaired Healing (A-PePSI) was established based on the identified risk factors. Results: In a cohort of 121 patients, 36 percent exhibited impaired healing. Of these, 34 patients suffered from dehiscences, necessitating surgical revision. Statistically significant risk factors comprising late recurrence (OR, 3.8), immobility (OR, 12.4), greater surface (>5 cm diameter; OR, 7.3), and inhibited thrombocytes (aspirin monotherapy; OR, 5.7) were combined to formulate a prognostic scoring system (A-PePSI LIGhT). Conclusions: The A-PePSI LIGhT score serves as a prognostic instrument for assessing individual risk for impaired healing in pressure sore patients. Preoperative risk stratification supports rational decision-making regarding operative candidacy, allows evidence-based patient counseling, and supports the implementation of individualized treatment protocols.

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“…Then, a more detailed description of the technique arrived in 2016 by Zhang et al (2016) with the name of "kissing" flaps. This procedure has been already described; however, the available works are still limited with few cases and specific application in a single district (Krakowczyk et al, 2021;Reddy et al, 2014;Wong et al, 2012;Zhao et al, 2017Zhao et al, , 2022. Moreover, most of them resort to local advancement flap.…”

Section: Introductionmentioning

confidence: 99%

The use of the chimeric conjoint flap technique for complex defects reconstruction throughout the body: Clinical experience with 28 cases

et al. 2022

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Background Large soft tissue defects reconstruction represents a frequent and complex challenge in plastic surgery. A critical point regards the equilibrium between the need of large amount of tissue, while minimizing donor site morbidity. This is a common issue that plastic surgeons face in their clinical practice. In this context, the chimeric conjoint flap technique can be a valuable option, allowing to better exploit many well‐known procedures. The purpose of the present work is to show the reconstructive efficacy and reliability of this technique resorting to many different well‐known flaps. No such a comprehensive collection of cases is available so far dealing with this procedure. Patients and Methods Twenty‐eight patients presenting large defects throughout the body were treated by means of different flaps, designed according to the chimeric conjoint flap concept. Patients' mean age was 61.9 years old (range 18–82 years), 20 were males and 8 females. The size of the defects ranged from 7 cm × 6 cm to 25 cm × 18 and presented shapes or localizations that were complex to be covered with a regular flap. The defects were located in 11 cases in the lower limbs, in 9 cases in the head and neck region, in 5 cases in the groin, and in 2 cases in the thorax. Cause of the defect was tumor resection in 20 cases, trauma‐induced necrosis in 5 cases, Fournier's gangrene in 2 cases, and a chronic ulcer in 1 case. Fourteen flaps were free flaps while 14 were pedicled flaps. The chimeric conjoint flap technique consists in splitting the skin paddle a flap into two smaller island that can be rearranged in order to match the particular requirements of the recipient site. Different flaps were employed: the anterolateral thigh (ALT) flap was used in 19 cases, latissimus dorsi (LD) musculocutaneous flap in 4 cases, deep inferior epigastric (DIEP) in 3 cases, medial sural artery perforator (MSAP) in 1 case, free radial forearm flap (RFFF) in 1 case. Results All the 28 patients were successfully treated. In 6 cases minor complications were encountered, 5 at recipient site and 1 at donor site, who were all managed conservatively. No second procedures were required. The mean follow‐up period was 8.4 months (range 3–12 months). At the last follow‐up evaluation all the patients reached an acceptable cosmetic result and, when limbs were affected, complete range of motion restoration. Conclusions The present case series provide promising evidence regarding the reliability and versatility of the chimeric conjoint flap technique for large and delicate defect reconstructions throughout the body.

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Couple-kissing flaps for successful repair of severe sacral pressure ulcers in frail elderly patients

Cited by 8 publications

References 29 publications

Single-cell analysis reveals melanocytes may promote inflammation in chronic wounds through cathepsin G

Single-cell analysis reveals melanocytes may promote inflammation in chronic wounds through cathepsin G

“A-PePSI LIGhT” Assessment Score to Predict Pressure Sore Impaired Healing Late Recurrence, Immobility, Greater Surface, Inhibited Thrombocytes

The use of the chimeric conjoint flap technique for complex defects reconstruction throughout the body: Clinical experience with 28 cases

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