单侧臀上动脉穿支螺旋桨皮瓣联合对侧向心性推进皮瓣修复骶尾部巨大压疮的临床效果

李军; 刘梦栋; 朱靓; 罗玉明; 杨琪瑛; 高晓文; 韩军涛

doi:10.3760/cma.j.cn501225-20231031-00158

单侧臀上动脉穿支螺旋桨皮瓣联合对侧向心性推进皮瓣修复骶尾部巨大压疮的临床效果

doi: 10.3760/cma.j.cn501225-20231031-00158

1.
空军军医大学第一附属医院烧伤与皮肤外科，西安　　710032
2.
空军军医大学军事预防医学系卫生事业管理和医学教育教研室，西安　　710032

基金项目:

国家自然科学基金面上项目 81971834

详细信息

通讯作者:
韩军涛，Email：xjburns@163.com

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出版历程
- 收稿日期: 2023-10-31

Clinical effect of unilateral superior gluteal artery perforator propeller flap combined with contralateral centripetal advancement flap in repairing huge pressure ulcers in the sacrococcygeal region

1.
Department of Burns and Cutaneous Surgery, the First Affiliated Hospital of Air Force Medical University, Xi'an 710032, China
2.
Department of Health Service Management and Medical Education, School of Military Preventive Medicine, Air Force Medical University, Xi'an 710032, China

Funds:

General Program of National Natural Science Foundation of China 81971834

More Information

Corresponding author: Han Juntao, Email: xjburns@163.com

摘要

摘要: 目的探讨单侧臀上动脉穿支螺旋桨皮瓣联合对侧向心性推进皮瓣修复骶尾部巨大压疮的可行性及其临床效果。方法该研究为回顾性观察性研究。2020年6月—2023年4月，空军军医大学第一附属医院收治15例符合入选标准的骶尾部缺损面积>10.0 cm×10.0 cm的Ⅳ期压疮患者，其中男8例、女7例，年龄30~86岁。清创前的压疮均伴有不同程度感染、坏死。Ⅰ期行清创术及负压封闭灌洗治疗，清创后皮肤软组织缺损面积为12.0 cm×10.5 cm~20.0 cm×17.0 cm。待创基感染控制后，Ⅱ期行单侧臀上动脉穿支螺旋桨皮瓣联合对侧向心性推进皮瓣修复压疮创面，穿支皮瓣面积为12.0 cm×7.0 cm~16.0 cm×10.5 cm。将供区创面直接拉拢缝合。术后，观察皮瓣成活、并发症及供区创面愈合情况。定期随访时，观察压疮复发情况、皮瓣外观与质地及供区瘢痕情况。结果术后，1例患者出现皮瓣下积液，经引流换药后成活，其余患者皮瓣均存活良好，无皮瓣下感染、局部坏死、窦道形成等情况；供区创面均愈合良好。所有患者均随访6个月以上，未见压疮复发；皮瓣外形无臃肿、质地柔软、抗压性及弹性好；供区创面愈合良好，瘢痕不明显。结论采用单侧臀上动脉穿支螺旋桨皮瓣联合对侧向心性推进皮瓣修复骶尾部巨大压疮的手术方式，操作简便易行，修复缺损面积大，供区可被直接缝合，值得临床推广。
- 骶尾部 /
- 压力性溃疡 /
- 穿支皮瓣 /
- 臀上动脉 /
- 推进皮瓣
Abstract: Objective To explore the feasibility and clinical effects of unilateral superior gluteal artery perforator propeller flap combined with contralateral centripetal advancement flap in repairing huge pressure ulcers in the sacrococcygeal region. Methods The study was a retrospective observational study. From June 2020 to April 2023, 15 patients with stage Ⅳ pressure ulcers with sacrococcygeal defect area greater than 10.0 cm×10.0 cm who met the inclusion criteria were admitted to the First Affiliated Hospital of Air Force Medical University, including 8 males and 7 females, aged from 30 to 86 years. The pressure ulcers before debridement were all accompanied by different degree of infection and necrosis. Debridement and negative pressure sealing and irrigation treatment were performed in stage Ⅰ. After debridement, the skin and soft tissue defect area was 12.0 cm×10.5 cm to 20.0 cm×17.0 cm. After the wound bed infection was controlled, unilateral superior gluteal artery perforator propeller flap combined with contralateral centripetal advancement flap was used to repair the pressure ulcer wounds in stage Ⅱ. The perforator flap area was 12.0 cm×7.0 cm to 16.0 cm×10.5 cm. The donor area wound was sutured directly. After operation, the survival, complications, and wound healing of flap donor area were observed. During regular follow-up, the recurrence of pressure ulcers, the appearance and texture of the flap, and the scars in the donor site were observed. Results After operation, 1 patient had fluid accumulation under the flap and survived after drainage and dressing change. The flaps of the other patients survived well without infection, local necrosis, and sinus formation under the flap. The wounds in the donor area healed well. All patients were followed up for more than 6 months, and there was no recurrence of pressure ulcers. The appearance of the flap was not bloated, the texture was soft, and the compression resistance and elasticity were good. The donor site wound healed well without obvious scar. Conclusions The surgical method of repairing giant sacrococcygeal pressure ulcers with unilateral superior gluteal artery perforator propeller flap combined with contralateral centripetal advancement flap is simple and easy to operate. It can repair large defect area with the donor area being sutured directly, which is worthy of clinical promotion.
- Sacrococcygeal region /
- Pressure ulcer /
- Perforator flap /
- Superior gluteal artery /
- Advancement flap
李军：酝酿和设计研究、设计和实施手术、采集资料、撰写论文；刘梦栋、高晓文：实施手术、采集资料、整理数据；朱靓：采集数据、分析/解释数据、对文章的知识性内容作批评性审阅；罗玉明、杨琪瑛：采集数据、分析/解释数据、制图；韩军涛：研究指导、对文章的知识性内容作批评性审阅、经费支持

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1 右侧臀上动脉穿支螺旋桨皮瓣联合左侧向心性推进皮瓣修复患者骶尾部Ⅳ期压疮创面的效果。1A.术前创面；1B.清创后创面；1C.于左侧臀部设计向心性推进皮瓣（箭头指示推进方向），右侧臀部设计臀上动脉穿支螺旋桨皮瓣；1D.术中掀起螺旋桨皮瓣，箭头指示穿支位置；1E.术中将皮瓣向创面顺时针螺旋桨式转移；1F.术后随访18个月时，皮瓣成活、质地柔软，供区瘢痕不明显

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