骶尾部慢性放射性溃疡的分期修复策略  

Staged repair strategy for chronic sacrococcygeal radiation ulcer

作　　者：程琳[1] 杜伟力[1] 张颖[1] 陈忠[1] 沈余明[1] Cheng Lin;Du Weili;Zhang Ying;Chen Zhong;Shen Yuming(Department of Burns,Beijing Jishuitan Hospital,Beijing 100035,China)

机构地区：[1]北京积水潭医院烧伤科,100035

出　　处：《中华烧伤杂志》2021年第3期225-231,共7页Chinese Journal of Burns

基　　金：北京市自然科学基金(7192082)。

摘　　要：目的探讨应用分期修复策略修复骶尾部慢性放射性溃疡的临床效果。方法采用回顾性队列研究方法。2010年1月—2020年6月,北京积水潭医院收治骶尾部慢性放射性溃疡患者12例,其中男7例、女5例,年龄38~74岁。Ⅰ期手术彻底清创,清创后创面面积为8 cm×6 cm~22 cm×14 cm,术后行持续负压封闭引流(VSD)治疗。Ⅱ期根据患者的年龄、全身状况、血管情况以及创面部位、大小、深度制订个性化修复方案,采用臀上/下动脉穿支皮瓣修复6例,臀大肌肌皮瓣修复4例,背阔肌肌皮瓣带蒂转移修复1例,背阔肌肌皮瓣游离移植修复1例。皮瓣或肌皮瓣面积为10 cm×8 cm~25 cm×18 cm。9例患者供瓣区直接缝合,3例患者供瓣区则采用背部中厚皮覆盖。观察术后皮瓣或肌皮瓣成活情况、肿瘤复发情况以及随访时皮瓣或肌皮瓣外观、质地和创面愈合情况。结果术后11例患者皮瓣或肌皮瓣成活;1例患者臀上动脉穿支皮瓣远端部分坏死,予以清创切除后,将皮瓣向远端推进。8例患者创面直接愈合;1例臀上动脉穿支皮瓣修复患者出现皮瓣下感染,1例臀上动脉穿支皮瓣修复患者皮瓣远端静脉充血,1例臀大肌肌皮瓣修复患者出现肌皮瓣下血肿,1例逆行背阔肌肌皮瓣修复患者出现切口渗液、裂开,经换药等处理后愈合。术后均未见肿瘤复发。出院后随访2~52个月,创面愈合良好,无感染复发;皮瓣或肌皮瓣质地柔软,外观良好;供瓣区愈合良好。结论在Ⅰ期彻底清创、VSD治疗的基础上,Ⅱ期采用血运丰富的臀上/下动脉穿支皮瓣、臀大肌肌皮瓣或者游离/带蒂背阔肌肌皮瓣修复骶尾部慢性放射性溃疡创面,方法可靠,供区损伤小,治疗效果较佳。Objective To investigate the clinical effect of staged repair strategy for chronic sacrococcygeal radiation ulcer.Methods The retrospective cohort study method was applied.Twelve patients with chronic sacrococcygeal radiation ulcer were admitted to Beijing Jishuitan Hospital from January 2010 to June 2020,including 7 males and 5 females,aged 38-74 years.The thorough debridement was performed in the first stage,with wounds area after debridement ranging from 8 cm×6 cm to 22 cm×14 cm,and continuous vacuum sealing drainage(VSD)was performed after the debridement operation.In the second stage,personalized surgery scheme was formulated according to the patient's age,systemic condition,vascular condition,and the position,size,and depth of wound.Six cases were reconstructed with superior/inferior gluteal artery perforator flaps,4 cases were repaired with gluteus maximus myocutaneous flaps,1 case was repaired with pedicled latissimus dorsi myocutaneous flap,and 1 case was reconstructed with free transplantation of latissimus dorsi myocutaneous flap.The area of flaps or myocutaneous flaps ranged from 10 cm×8 cm to 25 cm×18 cm.Donor sites of the flaps were sutured primarily in 9 patients and in the other 3 patients were repaired with intermediate split-thickness skin graft in back.The survival of flap or myocutaneous flap after operation,recurrence of tumor,and the appearance and texture of flap or myocutaneous flap,and wound healing were observed during follow-up.Results Flaps or myocutaneous flaps in 11 patients survived after operation,and superior gluteal artery perforator flap in 1 patient had partial distal necrosis,which was covered again with flap pushed to the distal after debridement and resection of the necrotic tissue.The wounds in 8 patients achieved primary healing,1 patient repaired with superior gluteal artery perforator flap experienced subcutaneous infection,1 patient repaired with superior gluteal artery perforator flap suffered distal venous congestion of the flap,and 1 patient repaired with gluteus

关 键 词：伤口愈合 骶尾部 放射性溃疡 臀部穿支皮瓣 臀大肌肌皮瓣 背阔肌肌皮瓣 

分 类 号：R61[医药卫生—外科学] R616.2[医药卫生—临床医学]