臀上动脉穿支皮瓣对骶尾部褥疮修复的临床应用

Application of superior gluteal artery perforator flap in the repair of sacral decubitus

关键词:  臀上动脉穿支皮瓣  骶尾部褥疮  难治性褥疮

Key words:  [Key words]　superior gluteal artery perforator flap  sacral decubitus  intractable decubitus

摘要:

[摘要]　目的　探讨臀上动脉穿支皮瓣修复骶尾部难治性褥疮的临床疗效。　方法　收集2004年3月—2012年4月骶尾部较大面积褥疮患者19例。其中Ⅲ度褥疮10例，Ⅳ度褥疮9例；男15例，女4例；年龄35~69岁；骶尾部褥疮面积11 cm×13 cm~22 cm×24 cm，平均17 cm×19 cm。术前常规采用多普勒超声探测穿支点并用龙胆紫标记，术前常规行臀部磁共振检查并筛除双臀肌纤维化的患者，应用臀上动脉穿支皮瓣对骶尾部褥疮创面进行覆盖，观察疗效。　结果　19例臀上动脉穿支皮瓣全部成活，术后随访3～39个月，平均23个月，皮瓣无臃肿，外形良好，褥疮无复发，臀大肌功能正常。　结论　臀上动脉穿支皮瓣血供丰富，可应用皮瓣范围大，切取方便，操作简单，保留臀大肌，无需植皮，是修复骶尾部难治性褥疮的理想方法。

Abstract:

[Abstract]　Objective　To investigate clinical efficacy of superior gluteal artery perforator flap in repairing sacral decubitus.　Methods　From March 2004 to April 2012, 19 patients with sacral decubitus were enrolled in the study aged from 35-69 years old, including 10 cases in stage Ⅲ and 9 cases in stage Ⅳ. 15 were male and 4 were female. Sacrococcygeal decubitus areas ranged from 11 cm×13 cm to 22 cm×24 cm, with an average of 17 cm×19 cm. Doppler ultrasound probe was used to detect wear fulcrum with gentian violet mark, and hip MRI was used to screen out patients with double gluteal muscle fibers. Sacrococcygeal decubitus wound was covered by the superior gluteal artery perforator flap.　Results　All of the 19 patients with superior gluteal artery perforator flaps survived and were followed up for 23 months (range from 3 to 39 months). The appearance of gluteal region were satisfactory without bloated shape or recurrence bedsores.　Conclusion　Superior gluteal artery perforator flap can be used efficiently in reconstruction of sacral decubitus. It provides rich blood supply, is easy to harvest and operate, and reserves the maximal function of the gluteus without skin graft.