臀上动脉穿支皮瓣在修复骶尾部压疮的应用
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摘要
目的:观察臀上动脉穿支皮瓣修复骶尾部压疮的效果。方法:收集采用臀上动脉穿支皮瓣修复大面积骶尾部压疮创面20例,压疮形成时间3个月至10年,创面大小为8 cm×7 cm～16 cm×12 cm,皮瓣切取范围14 cm×6.5 cm～20 cm×18 cm。结果:3例皮瓣出现远端小面积坏死,经换药等对症处理后Ⅱ期愈合,1例皮瓣在术后2 d出现静脉淤血及肿胀,采用部分清创及对侧臀上动脉穿支皮瓣修复创面,余16例皮瓣均Ⅰ期愈合,供区游离皮片生长良好,术后随访1年,皮瓣区外形良好,臀大肌外形及功能完好,无局部复发。结论:臀上动脉穿支皮瓣血供丰富,成活率高,设计灵活,是目前修复骶尾部压疮创面的理想方法。
Objective:To investigate the effects of superior gluteal artery perforator flap in repairing sacrococcygeal pressure sores.Methods:Twenty patients with sacrococcygeal pressure sores were repaired with superior gluteal artery perforator flap.The formation time of pressure sores ranged from 3 months to 10 years,the size of pressure sores ranged from 8 cm×7 cm to 16 cm×12 cm,and the size of flaps ranged from 14 cm×6.5 cm to 20 cm×18 cm.Results:Three cases with partial necrosis of flap were the secondary healing after symptomatic treatment,1 case with vein congestion and swelling at postoperative 2 days was treated with partial debridement and superior gluteal artery perforator flap repair,and the primary healing and good growth of free skin in the donor area in 16 cases were identified.All cases were followed up for 1 year,the shape of the flap area was good,the shape and function of gluteus maximus were intact,and there was not local recurrence.Conclusions:Superior gluteal artery perforator flap can provide rich blood supply,has high survival rate and flexible design,which is an ideal method to repair sacrococcygeal pressure ulcer wound.
Objective:To investigate the effects of superior gluteal artery perforator flap in repairing sacrococcygeal pressure sores.Methods:Twenty patients with sacrococcygeal pressure sores were repaired with superior gluteal artery perforator flap.The formation time of pressure sores ranged from 3 months to 10 years,the size of pressure sores ranged from 8 cm×7 cm to 16 cm×12 cm,and the size of flaps ranged from 14 cm×6.5 cm to 20 cm×18 cm.Results:Three cases with partial necrosis of flap were the secondary healing after symptomatic treatment,1 case with vein congestion and swelling at postoperative 2 days was treated with partial debridement and superior gluteal artery perforator flap repair,and the primary healing and good growth of free skin in the donor area in 16 cases were identified.All cases were followed up for 1 year,the shape of the flap area was good,the shape and function of gluteus maximus were intact,and there was not local recurrence.Conclusions:Superior gluteal artery perforator flap can provide rich blood supply,has high survival rate and flexible design,which is an ideal method to repair sacrococcygeal pressure ulcer wound.
引文
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[9] 傅重洋,李晓天,程超,等.臀上动脉穿支皮瓣修复骶尾部Ⅳ度褥疮[J].实用手外科杂志,2014,28(4):379.
[10] 范钦波,李健.臀上动脉穿支皮瓣对骶尾部褥疮修复的临床应用[J].大连医科大学学报,2015,37(3):250.
[11] 胡斯旺,戴开宇,梅劲,等.臀区穿支皮瓣的应用解剖学研究[J].中国临床解剖学杂志 2006,24(2):243.
[12] LIN CT,CHEN SY,CHEN SG,et al.Parasacral perforator flaps for reconstruction of sacral pressure sores[J].Ann Plast Surg,2015,75(1):62.
[13] JORDAN SW,DE LA GARZA M,LEWIS VL JR.Two-stage treatment of ischial pressure ulcers in spinal cord injury patients:Technique and outcomes over 8 years[J].J Plast Reconstr Aesthet Surg,2017,70(7):959.
[14] 王先成,李晓芳,鲁青,等.臀上或臀下动脉穿支皮瓣修复臀部褥疮[J].中华整形外科杂志,2010,26(2):113.
[15] 王付勇,李华强.负压封闭引流联合臀上动脉穿支皮瓣修复术治疗骶尾部压疮[J].中华实验外科杂志,2016,33(6):1682.
[2] LEVINE SM,SINNO S,LEVINE JP,et al.Current thoughts for the prevention and treatment of pressure ulcers:using the evidence to determine fact or fiction[J].Ann Surg,2013,257(4):603.
[3] KOSHIMA I,SOEDA S.Inferior epigastric artery skin flaps without rectus abdominis muscle[J].Br J Plast Surg,1989,42(6):645.
[4] 海恒林,李华涛,陈杨,等.双侧臀上动脉穿支蒂四叶皮瓣修复骶尾部巨大压疮[J].中国修复重建外科杂志,2013,27(3):308.
[5] CHEN W,JIANG B,ZHAO J,et al.The superior gluteal artery perforator flap for reconstructive of sacral sores[J].Saudi Med J,2016,37(10):1140.
[6] KIM CM,YUN IS,LEE DW,et al.Treatment of ischial pressure sores with both profunda femoris artery perforator flaps and muscle flaps[J].Arch Plast Surg,2014,41(4):387.
[7] MINAMI RT,MILLS R,PARDOE R.Gluteus maximus myocutaneous flaps for repair of pressure sores[J].Plast Reconstr Surg,1977,60(2):242.
[8] 柴益名,林崇正,马心赤,等.穿支蒂皮瓣修复臀骶部软组织缺损[J].中国修复外科重建杂志,2005,19(7):539.
[9] 傅重洋,李晓天,程超,等.臀上动脉穿支皮瓣修复骶尾部Ⅳ度褥疮[J].实用手外科杂志,2014,28(4):379.
[10] 范钦波,李健.臀上动脉穿支皮瓣对骶尾部褥疮修复的临床应用[J].大连医科大学学报,2015,37(3):250.
[11] 胡斯旺,戴开宇,梅劲,等.臀区穿支皮瓣的应用解剖学研究[J].中国临床解剖学杂志 2006,24(2):243.
[12] LIN CT,CHEN SY,CHEN SG,et al.Parasacral perforator flaps for reconstruction of sacral pressure sores[J].Ann Plast Surg,2015,75(1):62.
[13] JORDAN SW,DE LA GARZA M,LEWIS VL JR.Two-stage treatment of ischial pressure ulcers in spinal cord injury patients:Technique and outcomes over 8 years[J].J Plast Reconstr Aesthet Surg,2017,70(7):959.
[14] 王先成,李晓芳,鲁青,等.臀上或臀下动脉穿支皮瓣修复臀部褥疮[J].中华整形外科杂志,2010,26(2):113.
[15] 王付勇,李华强.负压封闭引流联合臀上动脉穿支皮瓣修复术治疗骶尾部压疮[J].中华实验外科杂志,2016,33(6):1682.