负压封闭引流联合保留臀上动脉浅支的臀大肌肌皮瓣修复骶尾部IV期压疮的临床效果

Clinical effect of negative pressure closed drainage combined with gluteus maximus myocutaneous flap preserving superficial branch of superior gluteal artery in the repair of stage IV sacrococcygeal pressure sore

目的:探讨负压封闭引流联合保留臀上动脉浅支的臀大肌旋转肌皮瓣修复骶尾部压疮的临床效果。方法:选取2019年6月—2023年10月温州医科大学附属第一医院收治的12例骶尾部压疮患者,其中男7例,女5例,年龄31~86岁。入院后I期予行负压封闭引流术,4~7 d后行保留臀上动脉浅支的臀大肌肌皮瓣修复创面。观察术后皮瓣成活情况、并发症发生情况,随访观察皮瓣外形、压疮复发情况。结果:本组12例患者,均因长期卧床致骶尾部受压出现IV期压疮,压疮病因:截瘫患者5例,各种原因所致的长期卧床患者7例,其中脑梗死后遗症患者2例,帕金森病患者3例,老年痴呆症患者1例,股骨颈骨折患者1例。病程2周至8年,清创后创面面积为5.0 cm×5.0 cm~10.0 cm×12.0 cm。12例患者术后皮瓣均完全成活,无皮瓣坏死、静脉淤血、创缘开裂等发生。术后随访2~6个月,皮瓣外形较佳、骶尾部软组织饱满、压疮无复发。结论:保留臀上动脉浅支的臀大肌旋转肌皮瓣血运可靠,设计、操作简单,皮瓣可修复面积大,切取不需要离断臀上动脉浅支,供瓣区一般能直接缝合,修复骶尾部压疮效果较佳。

Objective:To investigate the clinical effect of negative pressure closed drainage combined with gluteus maximus rotary musculoflap preserving the superficial branch of superior gluteal artery in the repair of sacrococcygeal pressure sore.Methods:A total of 12 patients with sacrococcygeal pressure sore from the First Affiliated Hospital of Wenzhou Medical University from June 2019 to October 2023 were selected,including 7 males and 5 females,aged 31-86 years old.After admission,the wound was repaired with a gluteus maximus myocutaneous flap preserving the superficial branch of the superior gluteus artery 4-7 days later.The survival and complications of the skin flap were observed.The shape of the skin flap and the recurrence of pressure sore were observed.Results:All the 12 patients in this group developed stageⅣpressure sores due to long-term bedridden sacrococcygeal compression.The causes of pressure sores included paraplegia in 5 patients and long-term bedridden for various reasons in 7 patients including 2 patients with cerebral infarction sequela,3 patients with Parkinson’s disease,1 patient with Alzheimer’s disease,and 1 patient with femoral neck fracture.The course of disease ranged from 2 weeks to 8 years,and the wound area after debridement ranged from 5.0 cm×5.0 cm to 10.0 cm×12.0 cm.All the 12 cases were completely alive after operation,and there was no flap necrosis,venous congestion or wound border cracking.After 2-6 months of follow-up,the flap shape was good,the sacrococcygeal soft tissue full,and the pressure sore did not recur.Conclusion:The gluteus maximus rotator myocutaneous flap with preservation of the superficial branch of the superior gluteal artery has reliable blood supply,simple in design and operation.The flap has a large repair area,and it does not need to cut off the superficial branch of the superior gluteal artery,and the donor site can generally be sutured directly,thus having an excellent effect in repairing sacrococcygeal pressure ulcer.