修复骶尾部缺损的皮瓣选择

Flap option in reconstruction of sacrococcygeal defect

目的依据骶尾部缺损的大小及深度,选择理想的皮瓣修复该区缺损,并减少创面复发。方法回顾性分析2017年10月至2019年12月苏州市立医院北区19例骶尾部皮肤软组织缺损患者,在直径小于5cm的缺损区周围,设计单侧或双侧任意皮瓣;直径大于5cm的缺损选择臀上动脉穿支皮瓣;多次手术伴有巨大软组织缺损的病例选用臀上动脉为蒂肌皮瓣,将皮瓣分离、移位修复创面,供区拉拢缝合或双叶皮瓣接力修复。结果术后皮瓣全部成活,无皮瓣坏死等并发症。19例患者获随访2月~28月,病变无复发,患者身心痛苦和护理负担减轻,对效果较满意。结论骶尾部缺损的修复以皮瓣为主,因软组织血运较好可以依据创面大小个体化选用旋转皮瓣、肌皮瓣和穿支皮瓣,设计灵活,手术后效果较好,极大减轻了患者的身心痛苦和护理负担。

Objective Choose optimal flap to repair different sacrococcygeal wounds according to defect’s size.abundance in order to reduce recurrence.Methods From October 2017 to December 2019,19 cases were selected for retrospective study in reconstruction of sacral defects.According to the radius of defect,when it was less than 5cm,unilateral or bilateral local random flap was utilized.when it was more than 5cm,perforator flap was designed.Given the complex scar after multiple operations with large tissue absence,the myocutaneous flap was chosen pedicled with superior gluteal artery.After the elevation and translocation of flap,the donor site could be closed primarily or repaired by bilobed island flap.Results All flaps survived without obvious complications such as necrosis.19 cases were followed and interviewed for 2 months to 28 months without recurrence.The patients were satisfied with the therapies for alleviation of pain and burden of nurse.Conclusion The sacrococcygeal wounds were mainly reconstructed by flap transplantation.With sufficient perfusion of soft tissue,random flap.perforator flap or myocutaneous flap was selected owing to dimension of defect individually.Excellent effects were obtained and the patients’satisfaction was concurred.