单侧臀大肌皮瓣过中线推进移植的臀沟抬高术治疗骶尾部藏毛窦的临床观察

Clinical Observation of Gluteal Fold Elevation with Unilateral Gluteal Maximus Myocutaneous Flap Transplanting Across Midline in Treatment of Sacrococcygeal Pilonidal Sinus

目的:探讨偏中线切除骶尾部藏毛窦(SPS)结节后应用单侧臀大肌皮瓣过中线推进移植的臀沟抬高术治疗SPS的可行性。方法:术前通过查体、彩超、CT或MR等检查明确藏毛窦结节的范围。术中偏中线完全切除SPS结节,在少切的一侧沿切口全长剥离臀大肌形成臀大肌皮瓣,跨人体后中线向多切一侧推进移植而抬高臀沟。术后采取以全臀弹性加压包扎联合持续负压引流产生“外压及内吸力”为基础的综合措施,使皮瓣与受区基底及四周缘紧贴,从而预防切口愈合不佳。结果:2015年6月至2023年6月共有14例SPS患者按上述方法治疗,有2例在皮瓣中段边缘出现小范围轻度瘀紫,经放松该处皮肤缝线减轻张力3 d,好转后再拉紧。其余均愈合良好。拆线后观察显示,14例臀沟均有不同程度的抬高,尤其是切口中段抬高较好。其中有3例切口远端臀沟抬高不明显,两者之间的高度差变大,使后者显得更为凹陷。但2个月后抬高的臀沟逐渐降低,以切口中段为明显,使切口远端臀沟凹陷相对减轻。随访6~72个月,中位随访时间为27个月,均无复发,且臀沟之外无瘢痕。结论:单侧臀大肌皮瓣过中线推进移植的臀沟抬高术治疗SPS,虽然小部分病例臀沟远端抬高不明显,但并未增加操作难度,且对SPS具有良好及稳定的疗效,明显降低了切口愈合不佳的发生率,臀沟之外无瘢痕,外观良好,具有较好的借鉴意义。

Objective To investigate the feasibility of gluteal fold elevation with unilateral gluteal maximus myocutaneous flap(GMMF)transplanting across midline after removing nodules of sacrococcygeal pilonidal sinus(SPS)in lateral side of midline in the treatment of SPS.Methods Physical examination,color ultrasound,CT or MR were performed before operation to determine the scope of the nodules of SPS.During the operation,the nodules of SPS were completely removed in the lateral side of midline.GMMF was formed along the full length of the incision on the side with less incision,and the gluteal fold was elevated by advancing the transplantation across the back midline to the side with more incision.After operation,a comprehensive measure based on"external pressure and internal suction"was taken to make the flap close to the base and surrounding edge of the recipient area,so as to prevent poor wound healing.Results From June 2015 to June 2023,a total of 14 SPS patients were treated according to the above method,and 2 cases had a small range of mild bruising at the middle edge of the flap.The tension was reduced by relaxing the skin suture for 3d,and then tightened after improvement.The others healed well.Observation after suture removal showed that 14 cases had different degrees of elevation of the gluteal fold,especially in the middle of the incision.In 3 cases,the elevation of the distal gluteal fold was not obvious,and the height difference between the two became larger,making the latter appear more depressed.However,after 2 months,the elevated gluteal fold gradually decreased,especially in the middle of the incision,and the gluteal fold depression at the distal end of the incision was relatively reduced.The median follow-up time was 27 months(6 to 72 months),and there was no recurrence and no scar outside the gluteal fold.Conclusion The gluteal fold elevation with unilateral GMMF transplanting across midline in the treatment of SPS does not increase the difficulty of operation,and has a good and stable effect on SPS,significantly reducing the incidence of poor incision healing,without scar outside the gluteal fold,with good appearance,and has good reference significance,although the elevation of the distal gluteal fold was not obvious in a small number of cases.