Staged repair strategy for chronic sacrococcygeal radiation ulcer

Objective: To investigate the clinical effect of staged repair strategy for chronic sacrococcygeal radiation ulcer. Methods: The retrospective cohort study method was applied. Twelve patients with sacrococcygeal radiation ulcer were admitted to Beijing Jishuitan Hospital from January 2010 to June 2020, including 7 males and 5 females with ages ranging from 38 to 74 years. The first stage of operation was thorough debridement, with the area of wounds after debridement ranging from 8 cm×6 cm to 22 cm×14 cm, and vacuum sealing drainage after the debridement operation. In the second stage, personalized surgery scheme was formulated according to the patient's age, systemic condition, vascular condition, and the position, size, and depth of wound. Six cases were reconstructed with superior/inferior gluteal artery perforator flap, 4 cases were repaired with gluteus maximus myocutaneous flap, 1 case was repaired with pedicled latissimus dorsi myocutaneous flap, and 1 case was reconstructed with free transplantation of latissimus dorsi myocutaneous flap. Donor sites of the flaps in 9 patients were sutured primarily and the other 3 patients were repaired with intermediate split-thickness skin graft in back. The survival of flap after operation, pathology, and the appearance, texture, and wound healing of flap during follow-up were observed. Results: Flaps in 11 patients survived completely after operation , and flap in 1 patient had partial distal necrosis, which was recovered after debridement, resection, and recovered with flap. The wounds in 8 patients achieved primary healing, 1 patient repaired with superior gluteal artery perforator flap experienced subcutaneous infection, 1 patient repaired with superior gluteal artery perforator flap suffered distal venous congestion of the flap, and 1 patient repaired with gluteus maximus myocutaneous flap had hematoma under flap, and 1 patient repaired with latissimus dorsi myocutaneous flap had incision exudation and dehiscence, which were all healed after dressing change, etc. The wounds healed well during follow-up after post-discharge of 2-52 months, with no recurrence of infection, soft flap texture, satisfactory appearance, and good healing of donor sites. Conclusions: On the basis of thorough debridement and VSD in the first stage, superior/inferior gluteal artery perforator flap, gluteus maximus myocutaneous flap, or latissimus dorsi myocutaneous flap with abundant blood supply was applied to repair chronic sacrococcygeal radiation ulcer in the second stage. The staged operation is reliable, with minimal injury to the donor site of flap and satisfactory therapeutic effect.