筋膜组织瓣及皮瓣分层缝合修复骶尾部藏毛窦切除后创面疗效观察

Effectiveness of fascial tissue flaps and skin flaps with layered sutures for repair of wounds after excision of sacrococcygeal pilonidal sinus

目的探讨筋膜组织瓣及皮瓣分层缝合修复骶尾部藏毛窦切除后创面的可行性和疗效。方法2019年3月—2022年8月收治9例骶尾部藏毛窦患者,男7例,女2例;年龄17~53岁,平均29.4岁。病程1~36个月,中位病程6个月。伴有肥胖和毛发浓密者7例,感染3例,窦道分泌物细菌培养阳性2例。病灶切除后创面范围3 cm×3 cm~8 cm×4 cm,深度3~5 cm、达肛周或尾骨;伴有肛周脓肿形成2例,尾骨炎性水肿1例。术中扩大切除,设计并切取臀部左、右两侧筋膜组织瓣及皮瓣,范围均为3.0 cm×1.5 cm~8.0 cm×2.0 cm。创面底部放置“十”字引流管,筋膜组织瓣及皮瓣推进分3层缝合,即筋膜层“8”字缝合、真皮层内倒刺线减张缝合、皮肤间断缝合。结果9例患者均获随访,随访时间3~36个月,平均12个月。所有切口均Ⅰ期愈合,无切口裂开、术区感染等并发症发生。均无窦道复发,臀沟外形满意,臀部两侧对称,局部切口瘢痕隐蔽,外形破坏最小。结论筋膜组织瓣及皮瓣分层缝合修复骶尾部藏毛窦切除后创面可有效填塞腔隙,降低切口愈合不良发生率,具有创伤小、操作简单的优点。

Objective To investigate the feasibility and effectiveness of fascial tissue flaps and skin flaps with layered sutures for repairing wounds after excision of sacrococcygeal pilonidal sinus.Methods Between March 2019 and August 2022,9 patients with sacrococcygeal pilonidal sinus were admitted,including 7 males and 2 females with an average age of 29.4 years(range,17-53 years).The disease duration ranged from 1 to 36 months,with a median of 6 months.There were 7 cases with obesity and dense hair,3 cases with infection,and 2 cases with positive bacterial culture of sinus secretion.The wound area after excision ranged from 3 cmx3 cm to 8 cmx4 cm,with a depth of 3-5 cm,reaching the perianal or caudal bone;there were 2 cases with perianal abscess formation and 1 case with caudal bone inflammatory edema.Enlarged resection was performed during operation,and the fascial tissue flap and skin flap were designed and excised at both left and right sides of the buttock,ranging from 3.0 cm×1.5 cm to 8.0 cm×2.0 cm.A cross drainage tube was placed at the bottom of the wound,and the fascial tissue flap and skin flap were advanced and sutured in three layers,namely,8-string sutures in the fascial layer,barbed wire reduction sutures in the dermis,and interrupted skin sutures.ResultsAll 9 patients were followed up 3-36 months,with an average of 12 months.All incisions healed by first intention,and no complication such as incisional dehiscence or infection in the operative area occurred.There was no recurrence of sinus tracts,the shape of gluteal sulcus was satisfactory,both sides of buttocks were symmetrical,local incision scar was concealed,and the shape disruption was minimal.Conclusion Fascial tissue flaps and skin flaps with layered sutures for repairing wounds after excision of sacrococcygeal pilonidal sinus can effectively fill the cavity and reduce the incidence of poor incision healing,with the advantages of small trauma and simple operation.