臀下动脉股后复合组织瓣修复骶尾部巨大压力性创面  

Posterior femoral composite tissue flap pedicled with inferior gluteal artery for repair of huge sacrococcygel pressure injuries

作　　者：官世水 沈佳祚 张力 林建聪 GUAN Shi-shui;SHEN Jia-zuo;ZHANG Li;LIN Jian-cong(Department of Orthopedics,Zhangzhou Hospital Affiliated to FujianMedical University,Zhangzhou Fujian 363000,China)

机构地区：[1]福建医科大学附属漳州市医院骨科,福建漳州363000

出　　处：《局解手术学杂志》2024年第9期800-804,共5页Journal of Regional Anatomy and Operative Surgery

摘　　要：目的探讨臀下动脉股后复合组织瓣修复骶尾部巨大压力性创面的临床疗效。方法回顾性分析我院收治的11例骶尾部巨大压力性创面患者的临床资料,创面平均面积(205.3±15.3)cm2,创面深度均达骶尾部骨面,伴部分骶尾骨坏死。术前使用超声多普勒血流探测仪探查臀下动脉及其穿支入皮点,根据创面设计臀下动脉股后复合组织瓣,然后进行骶尾部慢性创面修复。记录患者手术时间、术中出血量、创面愈合情况、术后皮瓣存活情况及并发症发生情况,监测受区创面皮瓣颜色、温度、两点辨别觉以评估皮瓣感觉敏感性,采用视觉模拟量表(VAS)评估外观满意度。结果本组患者手术时间(2.8±0.1)h,术中出血量(235.4±10.2)mL。11例患者术后臀下动脉股后复合组织瓣全部存活,1例术后皮瓣最远端部分坏死,经扩创、局部拉拢缝合后愈合良好;其余创面均一期愈合良好,无感染、脂肪液化、血肿等并发症发生。皮瓣色泽良好、质地柔软、弹性大,供区愈合良好。术后12个月,皮瓣温度、两点辨别觉、外观满意度VAS评分与术后其他时间点比较差异有统计学意义(P<0.05)。结论臀下动脉股后复合组织瓣血供恒定,不损伤主干血管,可顺行或逆行转位,操作简单,损伤较小,能重建皮瓣感觉,用于修复骶尾部巨大压力性创面临床疗效显著。Objective To investigate the clinical effect of posterior femoral composite tissue flap pedicled with inferior gluteal artery for repair of huge sacrococcygeal pressure injuries.Methods The clinical data of 11 patients with huge sacrococcygeal pressure injuries admitted to our hospital were retrospectively analyzed,with a mean wounds area of(205.3±15.3)cm2,and the depth of the wounds all reached the sacrococcygeal bone surface with partial sacrococcygeal necrosis.The inferior gluteal artery and its perforating branch were investigated with ultrasonic Doppler flow detector before operation,the posterior femoral composite tissue flap pedicled with inferior gluteal artery was designed according to the wound surface,and then the chronic sacrococcygeal wound was repaired.The operation time,intraoperative blood loss,wound healing,postoperative skin flap survival and occurrence of complications were recorded.The skin flap color,temperature and two-point discernability were monitored to evaluate skin flap sensory sensitivity.The visual analog scale(VAS)was used to evaluate the satisfaction of appearance.Results The operation time of patients was(2.8±0.1)hours and the intraoperative blood loss was(235.4±10.2)mL.The posterior femoral composite tissue flap pedicled with inferior gluteal artery of all the 11 patients survived.The distal part of the flap was necrotic in 1 case,which healed well after local debridement and suturing by amplification;other wounds healed well in the first stage without complications such as infection,fat liquefaction or hematoma.The skin flap has good color,soft texture,and good elasticity,with good healing in the donor area.There were significant differences in the skin flap temperature,two-point discernability and VAS score of appearance satisfaction between 12 months after operation and other time points(P<0.05).Conclusion The posterior femoral composite tissue flap pedicled with inferior gluteal artery has a constant blood supply,without damage to the main blood vessels.It can be transpose

关 键 词：臀下动脉 复合组织瓣 骶尾部 压力性损伤 慢性创面 

分 类 号：R622[医药卫生—整形外科] R659[医药卫生—外科学]