臀大肌肌皮瓣修复骶尾部褥疮的疗效观察

目的探讨应用臀大肌肌皮瓣修复骶尾部褥疮的临床疗效。方法应用带臀上动脉浅支或臀下动脉皮支的臀大肌皮瓣转移修复骶尾部褥疮12例。结果12例患者均一期修复,切取肌皮瓣面积14 cm×10 cm～10 cm×6cm,随访1～2年,肌皮瓣生长良好,无复发。结论应用臀大肌皮瓣修复骶尾部褥疮具有操作简便、皮瓣血运好、供区无需植皮、并发症少、成功率高、可一期完成修复等优点,是治疗骶尾部褥疮较理想的方法。     

股后侧岛状皮瓣和肌皮瓣的临床应用

目的 探讨应用股后侧岛状皮瓣修复大转子、骶部等处软组织缺损的临床效果.方法 应用顺行股后侧岛状皮瓣修复大转子软组织缺损4例、骶部2例;逆行股后侧岛状皮瓣修复腘窝部皮肤缺损2例;肌皮瓣修复坐骨结节褥疮4例;供区直接缝合.结果 除 1例岛状皮瓣远端发生尖部坏死经植皮愈合外,余病例术后全部成活.随访1～5年,供区愈合良好、受区外形、质地及厚薄均较满意.结论 该皮瓣以臀下动脉股后皮支及股深动脉穿动脉为其血供,解剖恒定,具有血运丰富、血管蒂长和切取容易等优点,适宜修复大转子、骶部坐骨结节及腘窝部等处软组织缺损.     

应用臀上动脉岛状肌皮瓣治疗骶尾部压疮的临床研究

目的:探讨应用臀上动脉岛状肌皮瓣治疗骶尾部压疮的临床效果。方法:2010年1月～2012年5月,收治11例骶尾部褥疮患者。男7例,女4例;年龄52～73岁。褥疮范围6cm×5cm～11cm×8cm。根据缺损部位及大小设计以臀上动脉为血管蒂的轴型岛状肌皮瓣移位修复骶尾部压疮。结果:术后肌皮瓣全部成活,10例伤口I期愈合,1例出现切口缘2cm长度的感染,经换药后愈合。随访3个月,移植肌皮瓣未见破溃,皮肤颜色及弹性均恢复较好,压疮无复发。结论:臀上动脉岛状肌皮瓣供血动脉恒定,切取方便,质地较厚耐磨,供区无需植皮,在臀骶部压疮的治疗效果较为理想。     

股后皮神经营养血管皮瓣修复臀骶部大面积软组织缺损中的应用

目的:探讨以股后皮神经营养血管为蒂的顺行岛状皮瓣修复臀骶部大面积软组织缺损的临床应用价值.方法:2005年7月～2012年2月期间收治28例臀部臀骶部大面积软组织缺损采用以股后皮神经营养血管为蒂的顺行岛状皮瓣修复,其中Ⅲ度褥疮23例,皮肤鳞状细胞癌3例,恶性纤维组织细胞瘤2例.其中男15例,女13例.年龄27～68岁.病程5～12个月.清创或肿瘤切除后臀骶部软组织缺损为12cm×5cm～15cm× 10cm,采用以股后皮神经营养血管为蒂的顺行岛状皮瓣修复,切取皮瓣范围12cm×5cm～15cm×10cm.供区宽度＜8 cm均可直接缝合,余植皮覆盖.结果:术后28例皮瓣全部成活,伤口及供区创面均Ⅰ期愈合,随访2.5～12个月,皮瓣质地、外观及感觉良好.均未再出现皮肤溃疡.结论:股后皮神经营养血管为蒂的顺行岛状皮瓣可为修复大面积臀骶部软组织缺损的首选.     

带臀上血管蒂臀大肌皮瓣修复骶尾部褥疮

骶尾部是褥疮的好发部位,由于骶骨后面仅皮肤覆盖,缺乏肌肉组织,一旦发生褥疮,常深达骶骨造成骶骨外露,较小范围的褥疮可以切除后直接缝合,或用邻近随意皮瓣修复,而巨大褥疮治疗困难,需用筋膜皮瓣,轴型皮瓣或肌皮瓣修复,我院采用以臀上动脉浅支血管为蒂的臀大肌上部肌皮瓣修复骶部褥疮,由于保     

应用肌皮瓣转移修复骶部褥疮

目的：报道应用肌皮瓣转移修复臀骶部褥疮的临床效果。方法：应用臀大肌皮瓣、臀中肌皮瓣、Guo绳肌皮瓣和阔筋膜张肌皮瓣转移修复臀骶部褥疮23例33处。供区直接缝合或游离植皮。结果：术后28处肌皮瓣全部成活。3处肌皮瓣边缘坏死，2处肌皮瓣边缘裂开，经换药及缝合后痊愈。全部病例均有随访。随访时间5个月－8年，均无褥疮复发。结论：臀骶部褥疮病史长，合并症多，应用肌皮瓣修复可获得较好的临床效果。     

臀上或臀下动脉穿支皮瓣修复臀部褥疮

目的 探讨保留臀大肌的臀上动脉或臀下动脉穿支皮瓣修复臀部褥疮.方法 术前常规用多普勒超卢探测仪探测穿支点并标记.设计将穿支点包括在内的不带臀大肌的臀上或臀下动脉穿支带蒂皮瓣修复臀部创面.结果 2006年8月至2009年5月临床应用15例,皮瓣大小为6cm×8 cm～7 cm×15 cm,术后皮瓣均完全成活,供区无血肿、血清肿等并发症发生.结论 臀上动脉或臀下动脉穿支皮瓣保留了臀大肌,血运可靠,能明显降低对供区的损伤,是修复臀部褥疮的一个良好选择.     

穿支动脉皮瓣修复骶尾部褥疮 15 例

目的 探讨应用穿支动脉皮瓣修复骶尾部褥疮的手术方法及临床效果. 方法 2000年1月-2006年10月,收治15例骶尾部褥疮患者.男10例,女5例;年龄49～75岁.Ⅲ度褥疮6例,Ⅳ度9例.褥疮范围5 cm×4 cm～10 cm×8 cm.根据缺损部位及大小设计以臀上、骶旁或腰动脉皮穿支为血管蒂的轴型穿支蒂皮瓣移位修复骶尾部褥疮.采用旋转移位皮瓣修复 11 例,皮瓣周围完全切开的岛状皮瓣修复 4 例. 结果 术中出血50～300 mL,无需输血.手术时间 1～2 h,无特殊不适.术后皮瓣全部成活,13 例伤口Ⅰ期愈合,2 例出现血肿和感染,经换药后愈合.住院时间20～40 d,平均29 d.随访1～5年,皮瓣质地优良,外形满意.皮肤颜色及弹性均恢复较好,褥疮无复发. 结论 穿支动脉皮瓣设计灵活、切取方便、血供可靠、不损伤臀部肌肉、供区无需植皮,是修复臀骶部褥疮的理想方法.     

岛状胸锁乳突肌肌皮瓣在面颊部复合组织缺损修复中的应用

目的 探讨岛状胸锁乳突肌肌皮瓣在面颊部复合组织缺损尤其是面颊部洞穿性组织缺损修复中的应用.方法 以胸锁乳突肌上端为蒂部,蒂部包含枕动脉,以乳突尖下2 cm处为肌皮瓣旋转轴点,根据缺损部位及大小进行肌皮瓣设计,以该点至缺损区最远点为肌瓣的长度,肌瓣宽度以稍大于创面宽度即可,但最大宽度不宜超过7 cm,下界不超过锁骨下2 cm.沿设计线切开,切断胸锁乳突肌起点,在胸锁乳突肌下分离切取皮瓣.蒂部仅包含胸锁乳突肌而不带皮肤.肌皮瓣经蒂部与缺损之间皮下隧道转移至缺损区,逐层缝合切口.供区视缺损大小可行直接拉拢缝合或邻近皮瓣转移或植皮修复.结果 应用岛状胸锁乳突肌肌皮瓣转移修复面颊部组织缺损12例,其中面颊部软组织肿瘤10例,颊部洞穿性缺损2例,术后肌皮瓣全部成活,被修复处色泽、厚度及外形均尚满意.结论 岛状胸锁乳突肌肌皮瓣血供丰富,血管恒定,切取及转移方便,是修复面颊部较大面积复合组织缺损的理想肌皮瓣.     

岛状胸锁乳突肌肌皮瓣在面颊部复合组织缺损修复中的应用

目的 探讨岛状胸锁乳突肌肌皮瓣在面颊部复合组织缺损尤其是面颊部洞穿性组织缺损修复中的应用.方法 以胸锁乳突肌上端为蒂部,蒂部包含枕动脉,以乳突尖下2 cm处为肌皮瓣旋转轴点,根据缺损部位及大小进行肌皮瓣设计,以该点至缺损区最远点为肌瓣的长度,肌瓣宽度以稍大于创面宽度即可,但最大宽度不宜超过7 cm,下界不超过锁骨下2 cm.沿设计线切开,切断胸锁乳突肌起点,在胸锁乳突肌下分离切取皮瓣.蒂部仅包含胸锁乳突肌而不带皮肤.肌皮瓣经蒂部与缺损之间皮下隧道转移至缺损区,逐层缝合切口.供区视缺损大小可行直接拉拢缝合或邻近皮瓣转移或植皮修复.结果 应用岛状胸锁乳突肌肌皮瓣转移修复面颊部组织缺损12例,其中面颊部软组织肿瘤10例,颊部洞穿性缺损2例,术后肌皮瓣全部成活,被修复处色泽、厚度及外形均尚满意.结论 岛状胸锁乳突肌肌皮瓣血供丰富,血管恒定,切取及转移方便,是修复面颊部较大面积复合组织缺损的理想肌皮瓣.     

Several types of gluteus maximus musculocutaneous flaps for closure of sacral decubitus ulcer — refinements in design

Summary The selection of gluteus maximus musculocutaneous flaps and the appropriate designs of such flaps are described. These flaps are based on either the superior gluteal pedicle or the inferior gluteal pedicle. Knowledge of the pedicle's position in relation to the skin surface is essential for correct design of the flap. We have treated 34 cases of sacral decubitus ulcer in which we have accomplished reconstruction with various types of gluteus maximus musculocutaneous flaps. Four representative cases are presented. Requests for reprints: A. Yanai, M.D.     

Musculocutaneous island flap using the upper gluteus maximus muscle]

The authors report 24 cases treated with an gluteus maximus musculocutaneous flap. The gluteus maximus is generally used as a VY flap. Our technique uses the superior part of the muscle with the overlying skin as a rotation flap. The upper part of the muscle is supplied by the superior gluteal artery. A good knowledge of the anatomy makes this flap easy to perform. The skin part of the flap is drawn over the trochanter. It is generally a 8 cm diameter circle. We then create a subcutaneous tunnel to prepare the rotation. The muscle is then freed from its lateral origin. The separation from the gluteus medius is made by blunt dissection and the superior gluteal artery can then be seen. The myocutaneous flap can now be raised and transferred to the defect. This flap has, in our experience, many advantages especially in paraplegic patients: large skin defects can be covered with a single flap, the perisacral skin is free of any scar, the lower part of the muscle can still be used to cover ischial ulcers. Since 1987 we have treated 24 patients with good results. The reliability and the great technical simplicity makes us think that the superior gluteus maximus musculocutaneous island flap is optimal for the coverage of sacral pressure sores.     

The total gluteus maximus rotation and other gluteus maximus musculocutaneous flaps in the treatment of pressure ulcers

The use of musculocutaneous flaps in the treatment of pressure ulcers has been widely accepted. This study presents the results of the use of various types of gluteus maximus musculocutaneous flaps such as island flaps, advancement flaps and new total gluteus maximus rotation flaps with or without an inferior gluteal fasciocutaneous extension, in the treatment of pressure ulcers.     

Comparative study of 2 surgical techniques in the treatment of ischial pressure ulcers in paraplegic patients. Retrospective study of 90 cases

This is a retrospective study concerning 90 paraplegic or tetraplegic patients with ischial pressure sores. Sixty-two patients were treated by gluteus maximus musculocutaneous island flap and 28 by VY hamstring myocutaneous flap. The authors describe the surgical technique of the two flaps. It is a one time surgery (excision and flap). There were 25% immediate complications for the patients who had VY hamstring myocutaneous flap and 27% for those who had gluteus maximus musculocutaneous island flap. There were 35% mid- and long-term recurrences with VY hamstring myocutaneous flap and 50% with gluteus maximus musculocutaneous island flap. The authors now use the gluteus maximus island flap for the small pressure scores and the VY bomstring flap for the big one which are near the anus.     

The distal gluteus maximus advancement musculocutaneous flap for coverage of trochanteric pressure sores

Large trochanteric pressure sores can be reconstructed with the superolateral advancement of the distal gluteus maximus-posterior thigh myofascial cutaneous flap. The flap has a dual blood supply derived from the gluteal system and the deep femoral artery. This makes the distal gluteus maximus advancement flap very reliable and versatile. It can be designed on the musculocutaneous perforators of the gluteal system alone or on its dual circulation. It has several advantages over previously described flaps for trochanteric pressure sores.     

Simultaneous bilateral breast reconstruction with superior gluteal artery perforator (SGAP) flaps

The superior gluteal artery perforator (SGAP) flap is a useful technique for restoration of the breast after mastectomy. If appropriately planned, the soft-tissue envelope supplied by the superior gluteal artery perforator vessels can be harvested with minimal donor site morbidity and often results in a highly esthetic restoration of the breasts. Dissection of the flap is performed with complete preservation of gluteus maximus muscle function. The resulting vascular pedicle obtained via dissection through the muscle is longer than that of gluteal musculocutaneous flaps and affords the surgeon the luxury of avoiding vein grafts in the anastomotic phase of surgery.Despite these advantages, use of the SGAP flap is not popular among reconstructive surgeons. Many practitioners are not familiar with the vascular anatomy of the gluteal area and may not be comfortable with the dissection of the parent vessels or lack the desire to practice microsurgery. On the other hand, our group has reported the largest experience to date with this method of breast reconstruction and has found the SGAP flap to be a reliable and safe method of autologous breast restoration in unilateral absence of the breast. Although the indications to perform single-stage gluteal tissue transplantation for bilateral breast restoration are uncommon, they do occasionally arise in clinical practice. We have carried out concurrent bilateral breast reconstruction using SGAP flaps on 6 patients with acceptable overall morbidity. All flaps went on to survive and resulted in highly esthetic restorations of the breast. Though a challenging undertaking, in-unison transfer of bilateral SGAP flaps serves as a useful option for a subset of patients desiring 1-stage bilateral breast reconstruction.     

Perforator propeller flaps for sacral and ischial soft tissue reconstruction

The perforator-based flaps in the sacral and ischial region is designed according to the localization of perforators that penetrate the gluteus maximus muscle, reach the intra-fascial and supra-fascial planes with the overlying skin forming a rich vascular plexus. The perforator-based flaps described in this article are highly vascularized, have minimal donor site morbidity, and do not require the sacrifice of the gluteus maximus muscle. In a period between April 2008 and March 2009, six patients with sacral pressure sore were reconstructed with propeller flap method based on superior gluteal and parasacral artery perforators. One flap loss was noted. Three cases of ischial pressure sore were reconstructed with longitudinal propeller flap cover, based on inferior gluteal artery perforator. One flap suffered wound infection and dehiscence. Two cases of pilonidal sinus were reconstructed with propeller flap based on parasacral perforators. Both the flaps survived without any complications. Donor sites were closed primarily. In the light of this, they can be considered among the first surgical choices to re-surface soft tissue defects of the sacral and ischial regions. In the series of 11 patients, two patients (18%) suffered complications.