Background:Traditional gluteus maximus myocutaneous flaps have generally been used to fill tissue defects after resection of sacrococcygeal pressure ulcers. However, postoperative complications were gradually revealed as increasing operations were performed. This study aimed to introduce the innovative application of gluteus maximus fasciocutaneous V-Y advancement flaps for repairing tissue defects and to comparatively analyze the differences between the innovative and traditional flaps.Methods:A total of 32 cases were included in this study. All the PU lesions were removed by resection. Sixteen cases used the gluteus maximus myocutaneous flaps, and the remaining 16 cases used gluteus maximus fasciocutaneous V-Y advancement flaps to fill the tissue defects after surgery. Comparative analysis between the gluteus maximus myocutaneous flaps and gluteus maximus fasciocutaneous V-Y advancement flaps was used to evaluate the 2 flaps based on the mean operating time, postoperative infection, paresthesia, appearance of flaps, and recurrence.Results:The gluteus maximus fasciocutaneous V-Y advancement flaps required a reduced operating time and a more simple operation compared with the gluteus maximus myocutaneous flaps. Although the infectious risk of the gluteus maximus fasciocutaneous V-Y advancement flaps was reduced compared with the gluteus maximus myocutaneous flaps, the gluteus maximus myocutaneous flaps have a better appearance compared with the gluteus maximus fasciocutaneous V-Y advancement flaps. Most importantly, no flap necrosis was noted, and the recurrence rate during follow-up was reduced in cases using the gluteus maximus fasciocutaneous V-Y advancement flaps.Conclusion:The combined application of gluteus maximus fasciocutaneous V-Y advancement flaps with surgical resection can reduce the postoperative complications and aid in the treatment of sacrococcygeal pressure ulcers.
A 37-year-old woman was referred to our center with a 3-day history of foreign body (FB) sensation after eating fish. Physical examination was unremarkable, and laboratory tests revealed leukocytosis (12.4 3 10 9 /L). Although EGD at the referring center was negative, computed tomography at admission revealed a definite high-density object in the cervical esophagus (a). Under general anesthesia, EGD was performed, showing mucosa erosion at the upper esophagus, but no FB was visible with careful inspection, suspicious of an esophageal FB entirely embedded in the submucosal tissue. Given that the patient's symptoms persisted, after a discussion of the multidisciplinary team, we attempted a submucosal endoscopy examination to explore the hidden FB. After submucosal injection, the mucosa was incised as entry at 17 cm from the incisors, followed by dissection of the submucosal tissue using a DualKnife. During the creation of the tunnel, there was no obvious FB, until a whitish object was noticed in the underlying muscular layer (b). The superficial muscular tissue was dissected, demonstrating a fish bone, which was then removed from the tunnel with a forceps (c). The mucosal entry was closed with 2 clips. With a short period of fasting and hospitalization, the patient was discharged smoothly. (Informed consent was obtained from the patient to publish these images.
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