臀部自由穿支皮瓣治疗骶尾部Ⅳ度压疮

The experience of free perforators flap in the treatment of patients with Ⅳ degree ischia-sacral ulcer

目的探讨采用臀部自由穿支皮瓣修复骶尾部Ⅳ度压疮的效果。方法2010年1月至2016年10月,遵义医学院附属医院烧伤整形外科收治骶尾部压疮患者18例,男14例,女4例,年龄16~68岁。骶尾部创面面积为4 cm×5 cm^8 cm×12 cm,应用多普勒超声血流探测仪探测穿支血管穿出点,根据创面大小、形状设计切取臀部自由穿支皮瓣修复,皮瓣面积为6 cm×11 cm^9 cm×15 cm。结果术后1例皮瓣裂开,创面再次形成,经再次手术行穿支皮瓣V-Y皮瓣推进修复;余17例皮瓣全部成活,随访3~24个月,皮瓣质地良好,外形不臃肿,无再次溃疡发生。结论臀部自由穿支皮瓣设计简单,不需追踪主干血管,手术切取简便,不破坏臀大肌,是修复骶尾部Ⅳ度压疮创面的理想方法之一。

Objective To investigate the design of free perforator flap, and the efficacy of utilizing perforator flaps for Ⅳ degree Ischia-sacral ulcer treatment. Methods From January 2010 to October 2016, 18 patients with Ⅳ degree ischia-sacral ulcer were treated. The surface area of the sacral tail ranged from 4 cm×5 cm to 8 cm ×12 cm.Doppler sonography was used to detect potential perforator.All defects were repaired with free perforator flaps, designed based on the size and shape of the wound. The flap size ranged from 6 cm×11 cm to 9 cm×15 cm. Results One perforator flap went dehiscence after surgery, repaired by V-Y flap. All the rest of perforator flaps survived well, after 3-24 months follow-up. Flap texture and appearance was good, no ulcer reoccurred. Conclusions The free perforator flap is a simple technique.It does not need to tracethe trunk of vessels, and it does not cause major morbidities to the buttocks. Therefore, it is one of the ideal ways to repair Ⅳ degree Ischia-sacral ulcer.