Objective:To investigate the clinical efficacy of perforator-based bilobed flaps in the treatment of stage 4 pressure ulcers.Methods:This retrospective observational study included 29 patients (21 males, 8 females) with stage 4 pressure ulcers admitted to the Department of Burn and Plastic Surgery and Wound Repair at Xuzhou First People's Hospital from August 2021 to May 2023. The patients' ages ranged from 12 to 82 (61.3±15.7) years. For ischial tuberosity pressure ulcers, reconstruction was performed using a posterior femoral bilobed flap based on the first perforator of the deep femoral artery, combined with a small gluteus maximus muscle flap. Sacrococcygeal pressure ulcers were repaired using a bilobed flap based on the superior or inferior gluteal artery perforator. Post-operative follow-up lasted for 2-36 months, during which flap survival and complications were assessed.Results:All the 29 bilobed flaps were successfully rotated and provided for adequate coverage without the need for pedicle division or perforator vessel dissection. Primary healing was achieved in 26 cases, with suture removal occurring two weeks post-operatively. Three patients experienced partial wound dehiscence and marginal necrosis due to post-operative pressure, which healed after two weeks of debridement and dressing changes. During follow-up for 2-36 months, no pressure ulcer recurrence was observed. The flaps demonstrated excellent survival, with soft texture, good elasticity, and adequate blood supply. The donor sites healed with only linear scars, and no severe complications were reported.Conclusion:Bilobed flaps based on artery perforators demonstrate excellent clinical outcomes in the treatment of stage 4 pressure ulcers.

Objective:To investigate the clinical efficacy of perforator-based bilobed flaps in the treatment of stage 4 pressure ulcers.Methods:This retrospective observational study included 29 patients (21 males, 8 females) with stage 4 pressure ulcers admitted to the Department of Burn and Plastic Surgery and Wound Repair at Xuzhou First People's Hospital from August 2021 to May 2023. The patients' ages ranged from 12 to 82 (61.3±15.7) years. For ischial tuberosity pressure ulcers, reconstruction was performed using a posterior femoral bilobed flap based on the first perforator of the deep femoral artery, combined with a small gluteus maximus muscle flap. Sacrococcygeal pressure ulcers were repaired using a bilobed flap based on the superior or inferior gluteal artery perforator. Post-operative follow-up lasted for 2-36 months, during which flap survival and complications were assessed.Results:All the 29 bilobed flaps were successfully rotated and provided for adequate coverage without the need for pedicle division or perforator vessel dissection. Primary healing was achieved in 26 cases, with suture removal occurring two weeks post-operatively. Three patients experienced partial wound dehiscence and marginal necrosis due to post-operative pressure, which healed after two weeks of debridement and dressing changes. During follow-up for 2-36 months, no pressure ulcer recurrence was observed. The flaps demonstrated excellent survival, with soft texture, good elasticity, and adequate blood supply. The donor sites healed with only linear scars, and no severe complications were reported.Conclusion:Bilobed flaps based on artery perforators demonstrate excellent clinical outcomes in the treatment of stage 4 pressure ulcers.

Objective: Hepatitis B surface antigen (HBsAg) loss is seldom achieved with nucleos(t)ide analog (NA) therapy in chronic hepatitis B patients but may be enhanced by switching to finite pegylated-interferon (Peg-IFN) alfa-2a. We assessed HBsAg loss with 48- and 96-week Peg-IFN alfa-2a in chronic hepatitis B patients with partial response to a previous NA. Methods: Hepatitis B e antigen (HBeAg)-positive patients who achieved HBeAg loss and hepatitis B virus DNA < 200 IU/mL with previous adefovir, lamivudine or entecavir treatment were randomized 1:1 to receive Peg-IFN alfa-2a for 48 (n = 153) or 96 weeks (n = 150). The primary endpoint of this study was HBsAg loss at end of treatment. The ClinicalTrials.gov identifier is NCT01464281. Results: At the end of 48 and 96 weeks' treatment, 14.4% (22/153) and 20.7% (31/150) of patients, respectively, who switched from NA to Peg-IFN alfa-2a cleared HBsAg. Rates were similar irrespective of prior NA or baseline HBeAg seroconversion. Among those who cleared HBsAg by the end of 48 and 96 weeks' treatment, 77.8% (14/18) and 71.4% (20/28), respectively, sustained HBsAg loss for a further 48 weeks. Baseline HBsAg < 1 500 IU/mL and week 24 HBsAg < 200 IU/mL were associated with the highest rates of HBsAg loss at the end of both 48- and 96-week treatment (51.4% and 58.7%, respectively). Importantly, extending treatment from 48 to 96 weeks enabled 48.3% (14/29) more patients to achieve HBsAg loss. Conclusion Patients on long-term NA who are unlikely to meet therapeutic goals can achieve high rates of HBsAg loss by switching to Peg-IFN alfa-2a. HBsAg loss rates may be improved for some patients by extending treatment from 48 to 96 weeks, although the differences in our study cohort were not statistically significant. Baseline and on-treatment HBsAg may predict HBsAg loss with Peg-IFN alfa-2a.