不同类型皮瓣用于修复臀骶部深度压疮手术方式选择  

Selection on operation mode of different types of skin flap in the repair of deep gluteal-lumbosacral pressure sore

作　　者：周忠志[1] 黄新灵[1] 熊武[1] 陈莹莹[1] 蔡煦[1] 杨双喜[1] 兰宏伟[1] 向聪莲 

机构地区：[1]湖南中医药大学第一附属医院烧伤疮疡整形外科,湖南长沙410007

出　　处：《中国美容医学》2016年第5期28-32,共5页Chinese Journal of Aesthetic Medicine

摘　　要：目的：回顾性分析5种不同类型皮瓣用于修复臀骶部深度压疮的手术方法和治疗效果,探讨压疮皮瓣修复的治疗策略和各类皮瓣的优缺点。方法：对123例142处臀骶部深度压疮行皮瓣转移修复术进行回顾性研究,归纳出带蒂局部旋转皮瓣23块、臀大肌肌皮瓣32块、腰臀筋膜皮瓣13块、穿支皮瓣43块、带蒂复合组织真皮瓣31块,共5种臀部皮瓣用于臀骶部深度压疮创面的修复,所有病例随访2月~2年,针对5种不同类型皮瓣从皮瓣设计、切取、转移修复及供区处理等方面进行归纳,提出行之有效的手术方式及方法。结果：一次性成活皮瓣134块,成功率为94.4%;术后出现切口裂开皮瓣5块,血运障碍皮瓣2块,皮瓣下血肿1块。所有出现并发症的压疮创面皮瓣经二期缝合后完全愈合。所有病例随访2月~2年,发现压疮愈合后组织深部积液1例,其余病例皮瓣形态功能良好,耐磨耐压,未发生破溃。结论：深度压疮修复以皮瓣填充效果最佳,皮瓣手术应遵循个体化原则,保障血运,预防并发症,方能使得手术成功更有保障。Objective To discuss the treatment strategies of flap repair for pressure scores and the advantages and disadvantages of each kind of skin flap through a retrospective analysis on surgical methods and curative effects of 5 different types of skin flap in the repair of deep gluteal-lumbosacral pressure score.Methods A retrospective analysis was carried out on 123 cases of patients with flap repair for deep gluteal-lumbosacral pressure score（142 sites）,and a total of 5 kinds of hip flap were concluded applied in the repair including 23 local rotational pedicle flaps,32 glutes maximums myocutaneous flaps,13 lumbar-glutealfascia flaps,43 perforators flaps,and 31 pedicle dermal flaps of composite tissue.All cases were followed up for 2 months to 2 years.We concluded the data of the 5 kinds of skin flaps from design,incision,transfer and repair to donor area treatment,and put forward effective operation mode and methods.Results A total of 134 flaps were survived,with the success rate of 94.4%;5 flaps appeared incision rupture after operation,2 flaps had blood supply disorder and 1 flap had subflap hematoma.All the flaps with complications were completed healed after secondary suture.All cases were followed up for 2 months to 2 years.1 patient was found effusion deep in the tissues after pressure score healing,while the other cases were all well recovered with flaps good in shape and functions,without rupture.Conclusion Skin flap filling has the best effects for the repair of deep pressure score,and the surgery should be individualized.Guaranteeing the blood supply and preventing complications are the guarantee of successful operations.

关 键 词：皮瓣 创面修复 深度压疮 手术 臀骶部 回顾性研究 

分 类 号：R622[医药卫生—整形外科]