局麻下应用岛状臀大肌肌皮瓣修复高龄患者骶尾部褥疮

Local anaesthesia in Island gluteus maximus musculocutaneous flap of Elderly patients with sacral rear pressure sores

探讨研究不能耐受全麻和硬膜外麻醉的高龄骶尾部褥疮患者的手术治疗。方法：局部麻醉,以髂后上棘到大转子尖端连线为轴心线,该线中上1/3处旋转点。根据缺损部位及大小进行肌皮瓣设计,形成内含臀上动脉浅支岛状肌皮瓣,皮瓣蒂宽1.5~2.0cm,含部分臀大肌外缘肌肉。然后通过皮下隧道转移修复骶尾部褥疮。结果：局麻下,应用臀上动脉浅支的岛状臀大肌肌皮瓣修复高龄患者骶尾部褥疮5例,术毕安返病房,术后肌皮瓣全部成活,被修复处色泽、厚度及外形均满意,供区臀大肌保持良好的伸髋功能。结论：高龄骶尾部褥疮患者难以耐受全麻或硬膜外麻醉,局麻安全、方便;岛状臀大肌肌皮瓣血供丰富,血管恒定,抗感染能力强;供区无需植皮;具有操作简单,并发症少,成功率高等优点,可一期完成骶尾部褥疮修复,减少工作量,缩短住院时间。

To explore the sacral rear pressure sores operating approaches for elderly patients who can not tolerate general and epidural anesthesia. Methods： Firstly, local anaesthesia was applied. The straight line connecting spina iliaca posterior superior and the tip of trochanter major was designed as the Axis of the myocutaneous flap. And up- per third point of the line was the rotation point of the flap. Island musculocutaneous flap was contrived depending on lo- cation and size of the defect ,which contained superficial branch of the superior gluteal artery, the width of the flap pedicle was 1.5-2.0 cm, and the pedicle contained portion of the outer edge of the gluteus maximus. Then repairing the sacral rear pressure sores by the subcutaneous tunnel. Results：Under local anesthesia, five cases of elder patients with the sacral rear pressure sores were treated by island gluteus maximus musculocutaneous flaps containing superficial branch of the supe- rior gluteal artery. All of the patients safely returned to the ward after the surgery. Transplanted myocutaneous flaps were all survived with good colour, thickness and texture, gluteus maximus from the area that provided flap maintained good hip extension function. Conclusion,＂ For elder patients, compared to general and epidural anesthesia, local anaesthesia was safer and more convenient. Island gluteus maximus myocutaneous flap has reliable blood supply, permanent blood vessel and powerful anti-infection capability. The area providing flap does not need skin graft. The surgery has advantage such as easy operation, fewer complication, higher success rate and etc.