臀上动脉螺旋桨皮瓣联合术后封闭负压治疗臀部压力性损伤效果分析

Clinical efficacy of superior gluteal artery propeller flap combined with postoperative vacuum sealing drainage in treatment of hip pressure injury

目的探讨应用臀上动脉穿支螺旋桨肌皮瓣联合术后负压吸引装置治疗臀部压力性损伤的临床效果。方法收集徐州仁慈医院2016年9月至2020年8月采用臀上动脉螺旋桨皮瓣联合术后负压治疗的压力性损伤患者32例。其中男性21例,女性11例;年龄14~79岁,平均56.87岁;压力性损伤分期:Ⅲ期12例,Ⅳ期20例;创面缺损面积30~56 cm^(2);术前评估患者各主要脏器功能均能耐受麻醉和手术操作,调整血红蛋白≥110 g/L,白蛋白≥30 g/L,观察皮瓣存活情况及治疗效果。结果患者均接受臀上动脉穿支螺旋桨皮瓣,术后予以封闭负压引流装置固定术野,术后31例皮瓣全部存活,其中1例患者术后因粪便污染出现皮瓣内侧边缘部分坏死,行乙状结肠造口后经换药处理后愈合,1例患者术后皮瓣供区缝合处因张力较大裂开继发感染,后期植皮修复。平均随访18个月,压力性损伤无复发。结论臀上动脉螺旋桨皮瓣血运可靠,操作简单,结合术后封闭负压吸引可降低术后并发症,治疗臀部压力性损伤效果较好。

Objective To investigate the clinical effectiveness of superior gluteal artery propeller flap combined with postoperative vacuum sealing drainage in the treatment of hip pressure injury. Methods From September 2016 to August 2020, 32 patients with hip pressure injury were treated with superior gluteal artery propeller flap combined with postoperative vacuum sealing drainage. They were 21 males and 11 females, at an average age of 56.87(14~79) years. There were 12 patients with type Ⅲ, and 30 with type Ⅳ. The defect ranged from 30 to 56 cm^(2). The patients’ ability to tolerate anesthesia and surgical operation for each major organ function was preoperatively evaluated. Their hemoglobin level was adjusted to ≥110 g/L and that of albumin to ≥30 g/L. The survival and therapeutic effect of the flap were observed. Results All patients were treated with superior gluteal artery propeller flap, followed by vacuum sealing drainage to maintain the operating field. All 31 flaps survived postoperatively. One patient suffered from necrosis of the medial edge of the flap due to fecal contamination, which was healed after sigmoid colostomy and redressing. Another patient suffered from secondary infection at the suture site of the flap due to high tension, and underwent skin graft later. The average follow-up period was 18 months, and there was no recurrence of pressure injury. Conclusions The superior gluteal artery propeller flap is reliable in blood supply and easy to operate. It is a reasonable option to combine with vacuum sealing drainage to reduce the complications after operation.