双侧反向臀上动脉远侧穿支V-Y推进筋膜皮瓣修复骶部巨大褥疮

Reconstruction of large sacral pressure ulcers with the double-opposing distal perforating superior gluteal arteries-based fasciocutaneous V-Y advancement flap

目的:笔者设计了一种双侧反向臀上动脉远侧穿支V-Y推进筋膜皮瓣,关闭巨大骶部溃疡,以增加皮瓣推进量,避免臀大肌功能性缺损。方法:清创后V-Y推进皮瓣标记于双侧臀部。在缺损近侧掀起筋膜皮瓣,在远侧臀大肌肌肉附件里保留臀上动脉远侧穿支,直至获得足够的皮瓣前移。结果:用此方法治疗15个直径7～15cm的骶部褥疮的患者,没有出现皮瓣坏死和溃疡复发,91%的皮瓣Ⅰ期愈合。结论:此技术使皮瓣推进量增加,皮瓣存活可靠,并保留了双侧臀部和臀大肌功能。

Objective We designed a double-opposing distal perforator-based fasciocutaneous V-Y advancement flap method for closing a large sacral pressure ulcer. The purposes of our method were to obtain sufficient advancement and to avoid a functional deficit of the gluteus maximus muscle. Methods After debriderment, the V-Y advancement flap is marked on the bilateral buttock. A fasciocutaneous flap is elevated from the medial part, preserving the distal perforating superior gluteal arteries in the distal muscular attachment of the gluteus maximus muscle until sufficient advancement of the flap is obtained. Results Fifteen patients with sacral pressure defects between 7 ~15 cm in diameter were treated using this surgical procedure. The results showed no flap necrosis and recurrence in any patient, and 91% percent of the flaps healed primarily. Conclusions The present technique accomplishes remarkable excursion of the bilateral V-Y fasciocutaneous flap, with high flap reliability and preservation of the contralateral buttock as well as gluteus maximus muscle function.