Clinical effects of superior gluteal artery perforator " buddy flap" in repairing pressure ulcer in sacrococcygeal region
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摘要: 目的 探讨臀上动脉穿支接力皮瓣修复骶尾部压疮的临床效果。 方法 2017年1月—2018年12月郑州大学第一附属医院收治骶尾部4期压疮患者13例,其中男8例、女5例,年龄24~79岁,创面面积5 cm×4 cm~12 cm×10 cm。彻底清创并行负压封闭引流后,设计臀上动脉穿支接力皮瓣修复骶尾部压疮,主瓣修复压疮,副瓣覆盖主瓣供区,主副瓣之间的连接瓣覆盖副瓣供区,其中主瓣面积7.0 cm×5.0 cm~18.0 cm×12.0 cm、副瓣面积5.0 cm×3.0 cm~11.0 cm×7.0 cm。皮瓣未覆盖的剩余创面直接拉拢缝合。观察术后皮瓣成活情况、并发症情况,随访皮瓣外观、功能及压疮复发情况。 结果 12例患者皮瓣术后成活,未出现感染、脂肪液化、皮瓣存活不良等并发症。1例皮瓣远端有小面积浅表皮肤坏死,经换药后愈合。所有患者随访6个月,术区外观自然饱满、耐压耐磨,均未见压疮复发。 结论 采用臀上动脉穿支接力皮瓣修复骶尾部压疮,可通过一次手术实现压疮与主要供瓣区无张力修复的效果,操作简单,疗效确切,有一定临床价值。Abstract: Objective To investigate the clinical effects of superior gluteal artery perforator " buddy flap" in repairing pressure ulcer in sacrococcygeal region. Methods From January 2017 to December 2018, 13 patients (8 males and 5 females) aged 24-79 years with stage 4 pressure ulcers in sacrococcygeal region were admitted to the First Affiliated Hospital of Zhengzhou University, with wound area from 5 cm×4 cm to 12 cm×10 cm. After thorough debridement and vacuum sealing drainage, the superior gluteal artery perforator " buddy flap" was designed to repair the pressure ulcer in sacrococcygeal region. The pressure ulcer was repaired by the main flap with area from 7.0 cm×5.0 cm to 18.0 cm×12.0 cm; the main flap′s donor area was covered by the auxiliary flap with area from 5.0 cm×3.0 cm to 11.0 cm×7.0 cm; the auxiliary flap′s donor area was covered by the connecting flap between the main flap and the auxiliary flap. The remaining wound without covering was directly closed by suturing. The postoperative flap survival and complications were observed. The appearance and function of flaps and the recurrence of pressure ulcer were followed up. Results The flaps of 12 patients survived after operation without complications of infection, fat liquefaction, or poor flap survival. A small area of superficial necrotic skin at the distal end of flap was observed in one case, which was healed after dressing change. All the patients were followed up for 6 months without recurrence of pressure ulcer, and the operation area was naturally full in appearance, which was pressure and wear resistant. Conclusions Superior gluteal artery perforator " buddy flap" is an effective method for the treatment of pressure ulcer in sacrococcygeal region. The effect of tension-free repair of the pressure ulcer and main flap donor area can be achieved in one operation. The operation is simple, the curative effect is accurate, and it has certain clinical value.
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