臀下动脉穿支蒂复合组织瓣修复骶尾部巨大褥疮的解剖与临床应用  

Anatomy study and clinical applications of complex tissue flap pedicled with inferior gluteal artery perforator for repairing giant sacrococcygeal pressure sore

作　　者：谢昀[1] 林建华[1] 叶君健[1] 郑和平[2] 

机构地区：[1] 福建医科大学附属第一医院骨科, 福州350001 [2] 南京军区福州总医院比较医学科

出　　处：《中华显微外科杂志》2014年第4期373-376,共4页Chinese Journal of Microsurgery

基　　金：福建省临床重点专科建设项目资助（xk201106）

摘　　要：目的 探讨臀下动脉穿支蒂臀大肌肌皮瓣联合股后皮神经营养血管皮瓣Ⅰ期修复骶尾部巨大褥疮的可行性及临床疗效. 方法 30侧动脉内灌注红色乳胶的成人下肢标本上,解剖观测：①臀下动脉的走行、分支与分布.②股后皮神经走行与分布.③臀下动脉股后皮支与股后皮神经营养血管间吻合关系.2007年5月至2013年7月共收治骶尾部巨大褥疮8例,皆为Ⅳ度,创面为16 cm×9 cm～22 cm×10 cm,皮瓣切取面积为32cm×10cm～25 cm×9 cm. 结果 臀下动脉出梨状肌下缘,管径（3.1 ±0.4）mm,发出2～5支肌支供应臀大肌.股后皮神经穿臀大肌下缘后沿股二头肌与半腱肌、半膜肌之间下行,在股骨内、外上髁连线上（5.9±0.8）cm处浅出深筋膜.臀下动脉的股后皮支与股后穿动脉、闭孔动脉股后皮穿动脉、腘窝直接动脉穿支在股后皮神经周围形成恒定的吻合.临床应用8例皮瓣皆Ⅰ期成活,术后14 d拆线,切口愈合良好,供区直接缝合关闭.门诊随访5个月～5年,皮瓣色泽正常,外观满意,骶尾部褥疮无复发. 结论 臀下动脉穿支蒂臀大肌肌皮瓣联合股后皮神经营养血管皮瓣血供良好,手术操作较简便,成活率高,可Ⅰ期修复骶尾部巨大褥疮.组织瓣解剖结构层次丰富,抗感染能力较强且耐磨,复发率低,临床效果满意.Objective To discuss the technical feasibility and clinical effectiveness of using complex tissue flap pedicled with inferior gluteal artery perforator for repair giant sacrococcygeal pressure sore.Methods Thirty embalmed lower limbs of adult cadavers perfused with red latex were used for anatomical study,and the followings were observed：①The course,branche and distribution of gluteal artery.②The course and distribution of the posterior femoral cutaneous nerve.③Anastomosis between the posterior cutaneous branch of gluteal artery and nutrient vessels of the posterior femoral cutaneous nerve.8 cases aging from 17 years to 56 years were completed during May 2007 to July 2013,6 cases were males and 2 cases were females.The sizes of pressure sore with the depth to Ⅳ degree were ranged from 16 cm × 9 cm to 22 cm × 10 cm.The sizes of flaps were harvested from 32 cm × 10 cm to 25 cm × 9 cm.Results The gluteal artery crossed the edge of the piriformis,the main stem was （3.1 ± 0.4） mm in diameter and gave out 2-5 muscular branches to supply the gluteus maximus.The posterior femoral cutaneous nerve crossed the edge of gluteus maximus and descended between biceps femoris and semitendinosus.Perforating deep fascia point located was （5.9 ± 0.8） cm above the line between medial and lateral femoral epicondyle.The constant anastomosis were formed by the posterior cutaneous branch of gluteal artery,the obturator artery perforator and the direct popliteal artery perforator around the posterior femoral cutaneous nerve.The complex flap survived successfully in all patients.Sutures were removed at 14 days postoperatively and the wounds healed well.All supplied areas were closed by directly suturing.Recurrent sacrococcygeal pressure sore was not observed in all cases with satisfied appearance and normal color during the outpatient follow-up period from 5 months to 5 years.Conclusion The united flap of gluteal myocutaneous flap and the posterior femoral cutaneous neurovascular flap pedicled with inferior gluteal

关 键 词：臀下动脉 穿支动脉 外科皮瓣 褥疮 应用解剖 

分 类 号：R632.1[医药卫生—外科学]