臀大肌远侧穿支V-Y皮瓣修复骶部褥疮  

DISTAL PERFORATOR-BASED GLUTEUS MAXIMUS MUSCLE V-Y FLAP FOR TREATMENT OF SACRAL ULCERS

作　　者：童仁联[1] 黄峻[1] 钟晓旻[1] 李叶扬[1] 

机构地区：[1]广州市红十字会医院暨南大学第四附属医院烧伤整形外科,广州510220

出　　处：《中国修复重建外科杂志》2006年第12期1208-1210,共3页Chinese Journal of Reparative and Reconstructive Surgery

摘　　要：目的探讨应用臀大肌远侧穿支V-Y皮瓣修复骶部褥疮,简化手术操作。方法2002年3月~2005年3月,对11例骶部褥疮应用臀大肌远侧穿支V-Y皮瓣修复。褥疮范围:13 cm×11 cm^18 cm×14 cm,褥疮最大直径达18 cm。其中男7例,女4例。年龄21~69岁。病程8个月~3年。手术彻底清创后,设计以褥疮外侧创缘为底部,顶在股骨大转子处的V形皮瓣,皮瓣的内侧半在臀大肌的浅面掀起,皮瓣的外侧部从臀大肌深面掀起,形成一包含外侧穿支的V形皮瓣。将皮瓣向内侧推进修复骶部创面,供区创面作V-Y缝合。结果11例骶部褥疮修复后,皮瓣全部成活。术后随访5个月~3年,双臀部对称,外形满意,除1例因其他疾病死亡外,余无褥疮复发。结论臀大肌远侧穿支V-Y皮瓣手术操作简便、血运丰富、蒂部较长、向内侧推进的幅度较大、皮瓣大及供区损害小且可直接缝合,是修复骶部较大的软组织缺损可供选择的一种方法。Objective To explore the method of the distal perforator-based gluteus maximus muscle V-Y flap to treat the sacral ulcer and to simplify the operative procedures. Methods From March 2002 to March 2005, 11 cases of sacral ulcer were repaired by distal perforator-based gluteus rnaximus muscle flaps. The area of sacral ulcer ranged from 13 cm×11cm to 18 cm ×14 cm. Of 11 cases, 7 were female and 4 were male, whose age ranged from 21 to 69 years, and the disease course was 8 months to 3 years. A triangular flap was designed to eremite a V-Y advancement flap. The length of the base was made almost equal to the diameter of the defect. The apex of the tringle was located near the great trochanter. The medial part of the flap was elevated as a fasciocutaneous flap by dissecting the layer between the fascia and the muscle. The distal part of the flap was elevated by dissecting the layer between the gluteus maximus muscle and the fascia of the deeper muscle group. The flap was advanced to the defect. Results All the flaps survived. After a follow up of 5 months to 3 years, the bilateral buttocks were symmetry and whose appearance was satisfactory. Except for 1 case dying of other disease, no recurrence of ulcer was observed. All the flaps survived. Conclusion The distal perforator-based fasciocutaneous V-Y flap for treatment of sacral ulcers is a simple and reliable technique, which has several advantages over the conventional V-Y flap technique,such as excelent excursion,viable coverage with the fasciocutaneous component, high flap reliability, preservation of the contralateral buttock, and preservation of the gluteus maximus muscle function.

关 键 词：骶部褥疮 臀大肌穿支皮瓣 修复 

分 类 号：R632.1[医药卫生—外科学] R622[医药卫生—临床医学]