蝴蝶形皮瓣修复骶部大面积褥疮  

The Coverage of a Large Sacral Pressure Sores with the Butterfly Flaps

作　　者：张功林[1] 陈克明[1] 李福民 黄尧 赵来绪 杨军林 周建华 薛钦义 

机构地区：[1]兰州军区总医院全军骨科研究所,甘肃兰州730050 [2]甘肃省民乐县中医院骨科,甘肃张掖734500 [3]甘肃省武山县人民医院骨科,甘肃天水741300

出　　处：《实用骨科杂志》2017年第10期891-894,共4页Journal of Practical Orthopaedics

摘　　要：目的报告蝴蝶形皮瓣修复骶部大面积褥疮的临床结果。方法自2006年3月至2010年10月间,应用这种技术修复6例(男5例,女1例)骶部大面积褥疮。年龄22~58岁,平均38岁。其中完全性脊髓损伤3例,烫伤2例,脑梗塞1例。均为骶部Ⅳ度褥疮,深度达骨面。创面大小:12cm×14cm^13cm×18cm。每侧皮瓣均以第4腰动脉穿支为蒂,皮瓣轴斜向髂前上棘,皮瓣的外形类似一只蝴蝶。供区缺损一期缝合。结果 1例术后发生表浅感染,经更换敷料逐渐愈合。所有患者经26~52个月随访(平均38个月),皮瓣全部成活。所有缺损均修复成功,没有发生伤口血肿与裂开。骶部褥疮没有复发,取得了较满意的效果。结论蝴蝶形皮瓣技术是修复骶部褥疮较好的治疗方法,当病例选择适当时,并发症少,成功率高。Objective To report the clinical results of the coverage of a large sacral pressure sores with the butterfly flap.Methods Between March 2006 and October 2010,6 cases a large sacral pressure sores（5 men,1 women）were reconstructed with the technique.They ranged in age from 22 to 58 years（mean 38）.Of the 6 cases,3 cases were complete spinal cord injury.Two were burn injury.One was cerebral infarction.All of the patients had stage Ⅳ decubitus ulcers that extended to the bone.The pressure sores ranged in size from 12 cm×14 cm to 13 cm×18 cm.Each flap was pedicled on the fourth lumbar artery perforators,The flaps designed with the axis obique to the anterior superior iliac spine.The configuration of the flaps resembles a butterfly.Donor sites defect were closed primarily.Results One case sustained superficial infection postoperative and the gradual wound healed by daily wound dressings.All patients were followed-up from 26 to 52 months（mean,38 months）.All flaps survived;hematoma,or wound dehiscence was not observed.No recurrence of the sacral pressure sores occurred with satisfactory clinical results.Conclusion The butterfly flap technique is a reliable surgical method for sacral pressure sores reconstruction.When used in appropriate cases,there is minimal morbidity and the outcome is highly successful.

关 键 词：褥疮 骶骨 外科皮瓣 腰动脉穿支 

分 类 号：R622.1[医药卫生—整形外科]