骶旁动脉穿支皮瓣治疗藏毛疾病的临床应用  

Clinical application of parasacral artery perforator flap in the treatment of Pilonidal Sinus Diseases

作　　者：兰俊红 陈昭宏[2] 范月莹 韩璐 王涛 贾赤宇 何伟玲 Lan Junhong;Chen Zhaohong;Fan Yueying;Han Lu;Wang Tao;Jia Chiyu;He Weiling(Department of Aesthetic Plastic Surgery and Wound Repair,Xiang'an Hospital,Xiamen University,Xiamen 361000,China;Department of Burns and Wound Repair,Union Hospital of Fujian Medical University,Fuzhou 350001,China;Department of Burns and Plastic Surgery,the First Affiliated Hospital of Nanhua University,Hengyang 421001,China;Department of Gastrointestinal Surgery,Xiang'an Hospital,Xiamen University,Xiamen 361000,China)

机构地区：[1]厦门大学附属翔安医院整形美容与创面修复科,厦门361000 [2]福建医科大学附属协和医院烧伤与创面修复科,福州350001 [3]南华大学附属第一医院烧伤整形科,衡阳421001 [4]厦门大学附属翔安医院胃肠外科,厦门361000

出　　处：《中华胃肠外科杂志》2024年第9期970-973,共4页Chinese Journal of Gastrointestinal Surgery

基　　金：2022年度厦门市医疗卫生指导性项目(3502Z20224ZD1154);烧创伤重点实验室(福建医科大学附属协和医院)课题(XHZDSYS202005);厦门大学附属翔安医院2022年度青年科研基金(XAH22005)。

摘　　要：目的探讨骶旁动脉穿支皮瓣修复藏毛疾病切除后创面的临床效果。方法主要手术操作步骤如下:(1)术前手持多普勒探测骶旁穿支血管并标记;(2)彻底切除藏毛疾病的感染坏死组织;(3)根据创面大小及穿支血管的位置设计骶旁动脉穿支皮瓣;(4)于臀大肌表面切取并转移皮瓣,无张力覆盖创面。记录手术时长、皮瓣长度和宽度、引流管放置时间、住院时间、拆线时间、术后并发症以及复发情况等指标。结果厦门大学附属翔安医院烧伤与创面修复科于2021年3月至2023年3月期间采用骶旁动脉穿支皮瓣治疗了6例藏毛疾病患者。其中男性5例,女性1例,平均年龄24(18~33)岁。平均手术时长为165(134~207)min,平均皮瓣长度为8(7~11)cm,平均皮瓣宽度为3(3~4)cm,平均引流管放置时间8(4~17)d,平均住院时间为13(6~23)d,平均拆线时间为14(14~17)d。随访6~16个月,全部患者均一期愈合,均无皮瓣坏死、皮瓣积血、手术切口感染及裂开以及切口长期不愈合等早期和晚期术后并发症。随访过程中均未出现愈合后再感染复发。结论骶旁动脉穿支皮瓣应用于藏毛疾病切除后创面修复,疗效佳且安全可行。Objective To investigate clinical efficacy of parasacral perforator flap(PPF)on postoperative wound healing in pilonidal sinus diseases(PSDs).Methods The surgery steps were as follows:(1)To preoperatively detect parasacral perforator arteries with the handhold Doppler probe and mark them;(2)To remove the infected and necrotic tissues of PSDs completely;(3)To design the PPF according to the wound size and the parasacral perforator arteries'localization;(4)To harvest the flap from the gluteus maximus muscle surface and transfer it to the wound without tension.Several data were documented,including surgical duration,flap length,flap width,drainage tube placement duration,hospital stay,duration from operation to stitch removal,postsurgical complications and recurrence.Results There were six patients with PSDs whose postoperative wound healing was repaired by PPF,admitted in our department from March 2021 to March 2023.Of them,five were male and one was female.Their median age was 24(range:18-33)years old.Their median surgical duration was 165(range:134-207)minutes,median length of PPF was 8(range:7-11)cm,median width of PPF was 3(range:3-4)cm,mean duration of drainage tube placement was 8(range:4-17)days,mean hospital stay was 13(range:6-23)days,mean duration from operation to stitch removal was 14(range:14-17)days,median follow-up time was 6-16 months.Incisions of all six cases achieved first-intention healing without early-or late-stage complications.No recurrence occurred during follow-up.All patients involved were satisfied with their clinical efficacy.Conclusion The utility of PPF in postoperative wound healing of PPDs was effective,safe and reliable.

关 键 词：藏毛疾病 藏毛窦 藏毛囊肿 骶旁动脉穿支皮瓣 

分 类 号：R635[医药卫生—外科学]