臀上动脉穿支岛状皮瓣修复骶尾部压疮的临床效果

Clinical effects of superior gluteal artery perforator island flap in repair of sacral pressure ulcer

目的探讨臀上动脉穿支岛状皮瓣修复骶尾部压疮的临床效果。方法2012年5月—2017年5月,笔者单位收治20例骶尾部压疮患者,其中男14例、女6例,年龄27~67岁。根据2016年美国国家压疮指导专家组的共识分期,6例患者压疮为3期、14例患者压疮为4期,压疮范围5.0cm×4.0cm^10.0cm×8.0cm。清创及行负压封闭引流后应用臀上动脉穿支岛状皮瓣修复压疮创面,皮瓣面积为6cm×5cm^13cm×8cm,供区均直接拉拢缝合。观察术后皮瓣成活、伤口愈合情况及患者随访情况。结果20例患者术后皮瓣均存活良好,无再次手术病例。本组患者住院时间为20~40d,平均25d。其中18例患者获随访6~24个月,平均12.2个月,皮瓣外形良好,弹性恢复可;供区无血清肿及血肿等并发症发生;患者及家属均对皮瓣外形和质地及臀部外形表示满意。结论臀上动脉穿支岛状皮瓣血运可靠,旋转方便,皮瓣可携带少许肌肉增加抗感染能力,供区可直接缝合且损伤小,是修复骶尾部压疮的较佳方法之一。

Objective To explore the clinical effects of superior gluteal artery perforator island flap in repair of sacral pressure ulcer.Methods From May 2012 to May 2017,20 patients with sacral pressure ulcers(14 males and 6 females,aged 27 to 67 years)were admitted to our department.According to the consensus staging system of National Pressure Ulcer Advisory Panel in 2016,6 cases were in 3 stages,14 cases were in 4 stages,with the area of pressure ulcers ranging from 5.0 cm×4.0 cm to 10.0 cm×8.0 cm.After debridement and vacuum sealing drainage,the superior gluteal artery perforator island flaps were used to repair the pressure wounds,with the area of flaps ranging from 6 cm×5 cm to 13 cm×8 cm.The donor sites were sutured directly.The survival of flaps after operation,the healing of wounds,and the follow-up of patients were observed.Results After surgery,flaps of 20 patients survived well without reoperation.The length of hospital stay of patients was 20 to 40 days,with an average of 25 days.Eighteen patients were followed up for 6 to 24 months,with an average of 12.2 months.The flaps were in good shape and elastic recovery.There were no complications such as seroma or hematoma in the donor sites.Both the patients and family members expressed satisfaction with the shape and texture of the flap and shape of hip.Conclusions The superior gluteal artery perforator island flap is reliable in blood supply and easy to rotate.The flap can carry a little muscle to increase the anti-infective ability.Moreover,the donor site can be directly sutured with slight damage.Thus,it is one of the good methods for repairing sacral pressure ulcers.