个性化皮瓣修复臀骶周围深度压疮疗效观察

Observation on the Curative Effect of Personalized Skin Flap for Repairing Deep Pressure Sore Around Gluteal Sacrum

目的:探讨个性化皮瓣修复臀骶周围深度压疮的临床疗效。方法:选择2017年6月-2020年6月笔者医院收治的68例臀骶周围深度压疮患者为研究对象,根据患者创面情况分别采用旋股外侧动脉降支带蒂皮瓣、臀部自由穿支螺旋桨皮瓣及臀下动脉股后皮支复合组织瓣等手术方法修复臀骶周围深度压疮,观察患者疗效。结果:本组68例患者,其中行臀部自由穿支螺旋皮瓣修复32例;旋股外侧动脉降支带蒂(肌)皮瓣修复18例;臀下动脉股后皮支复合组织瓣修复14例;任意皮瓣修复4例。术后皮瓣一期愈合64例,延期愈合4例,其中1例高位截瘫患者患肢痉挛性瘫痪导致皮瓣裂开,经换药后愈合,其他3例皮瓣下淤血伴感染,经再次手术后愈合。术后随访6~12个月,所有患者皮瓣色泽、张力均正常,且耐磨耐压,患者对外观效果均较满意。结论:对臀骶周围深度压疮创面采用个性化皮瓣手术修复治疗,皮瓣血运良好,成活率高,创面修复效果好,对臀骶部外形功能影响小,患者满意率高。

Objective To investigate the clinical efficacy of personalized flaps for repairing deep pressure ulcers around the gluteal sacrum.Methods 68 patients with deep pressure sores around the gluteus sacral were selected from the author's hospital from June 2017 to June 2020 as the research objects.According to the wound conditions of the patients,the flap with the pedicle of the descending branch of the lateral circumfl ex femoral artery,the propeller flap of the free perforating branch of the buttock and the composite tissue flap of the posterior cutaneous branch of the inferior gluteus artery were used to repair the deep pressure sores around the gluteus sacral.Results In this group of 68 patients,32 of them were repaired with hip free perforator spiral flap.Repair of flap with pedicle(muscle)in descending branch of lateral circumfl ex femoral artery in 18 cases;Inferior gluteal artery femoral posterior cutaneous branch composite flap repair in 14 cases;4 cases were repaired with arbitrary skin flap.The flap healed in one stage after operation in 64 cases.There were 4 cases of delayed healing,among which 1 case of high paraplegia sufiered spasmodic paralysis resulting in flap split and healed after dressing change,and the other 3 cases of subcutaneous congestion with infection healed after reoperation.All the patients were followed up for 6-12 months after operation.The skin flap color and tension were normal,and the skin flap was wear resistant and pressure resistant.Conclusion The surgical treatment of deep pressure ulcer around the gluteus sacral area with personalized skin flap showed good blood fl ow,high survival rate,good wound repair efiect,little impact on the shape and function of the gluteus sacral area,and high patient satisfaction rate.