臀上或臀下动脉双叶皮瓣修复老年臀部压疮的效果

Efficacy of superior or inferior gluteal artery bilobed flap in repairing hip pressure ulcers in elderly patients

目的探讨臀上或臀下动脉双叶皮瓣修复老年臀部压疮的效果。方法回顾性分析2015~2021年我院收治的21例老年臀部4期压疮病人的临床资料,其中应用臀上动脉双叶皮瓣修复13例,臀下动脉双叶皮瓣修复8例。观察病人术后皮瓣血运及成活情况、伤口愈合情况、并发症发生情况;病人出院后,门诊复诊随访观察臀部供区与受区外观及压疮是否复发。结果病人清创或扩大切除后的创面面积为7.5 cm×6 cm~12 cm×10 cm,所有病人皮瓣全部成活且血运良好,无切口裂开发生。20例病人皮瓣Ⅰ期愈合;1例病人术后5 d皮瓣出现一处2 cm×2 cm创面,局部感染沿皮下潜行,经清创、换药,延期缝合后Ⅲ期愈合。随访1~12个月,所有病人臀部供区与受区外形平整,压疮无复发。结论臀上或臀下动脉双叶皮瓣较好地解决了单叶皮瓣供瓣区张力大的问题,皮瓣血运可靠,术后并发症少,臀部供区与受区外形恢复良好,尤其适用于修复伴有动脉血管硬化闭塞的老年臀部压疮。

Objective To investigate the effects of superior or inferior gluteal artery bilobed flap in repairing hip pressure ulcer in the elderly patients.Methods The clinical data of 21 elderly patients with stage 4 gluteal pressure ulcer admitted to our hospital from 2015 to 2021 were retrospectively analyzed.Among them,13 cases were repaired with superior gluteal artery bilobed flap and 8 cases were repaired with inferior gluteal artery bilobed flap.The situations of blood supply and survival of the flap,wound healing and complications were observed.After discharge,the patients were followed up for the appearance of the hip donor and recipient areas and recurrence of the pressure ulcer.Results The wound area after debridement or extended resection ranged from 7.5 cm×6 cm to 12 cm×10 cm.All flaps survived with good blood supply and no incision dehiscence occurred.The flap healed by the first stage in 20 patients.One patient presented with a 2 cm×2 cm wound on the flap 5 days after operation,and the local infection crept along the subcutaneous area.After debridement,dressing change and delayed suture,the flap healed by stageⅢ.All patients were followed up for 1 to 12 months.The appearance of the donor and recipient areas of the buttocks was smooth and there was no recurrence of pressure ulcer.Conclusions The superior gluteal artery or inferior gluteal artery double leaf flap can solve the problem of high tension in the donor area of single leaf flap,with reliable blood supply of the flap,less postoperative complications and well restored appearance of the donor area and the recipient area,which is especially suitable for repairing hip pressure ulcer in the elderly patients with atherosclerosis occlusion.