穿支蒂皮瓣修复臀骶部软组织缺损

目的探讨应用穿支蒂皮瓣修复臀骶部软组织缺损的手术方法及临床效果。方法1998年以来临床应用8例,其中男5例,女3例。年龄15～79岁。根据缺损部位及大小设计以臀部、骶旁或腰动脉的皮穿支为血管蒂的轴型穿支蒂皮瓣移位修复臀骶部褥疮、溃疡及外伤性软组织缺损创面。切取皮瓣达6cm×5cm～19cm×11cm,穿支血管口径1.3～2.1mm,游离穿支血管蒂长度为2.5～4.5cm。结果皮瓣全部成活,伤口期愈合。随访6～24个月,皮瓣质地优良,外形满意,溃疡无复发。结论穿支蒂皮瓣设计灵活,切取方便,血供可靠,不损伤臀部肌肉,供区无需植皮,是修复臀骶部软组织缺损创面的理想方法。     

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.     

应用臀上动脉穿支皮瓣联合负压封闭引流修复骶尾部压疮

目的 观察应用臀上动脉穿支皮瓣联合负压封闭引流修复骶尾部压疮的治疗效果.方法 对13例(20处)骶尾部压疮患者的创面(5 cm× 10 cm～ 14 cm×17 cm)均采用臀上动脉穿支V-Y推进皮瓣联合负压封闭引流术治疗.结果 本组共13例患者,术后20处臀上动脉穿支岛状皮瓣均成活,创面Ⅰ期愈合.随访6～48个月,其中1例患者复发,其余患者情况良好.结论 应用臀上动脉穿支V-Y推进皮瓣联合持续负压引流修复骶尾部压疮的方法,操作简单、安全、有效,值得临床推广应用.     

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.     

臀部皮瓣修复骶尾部、臀部、坐骨结节部压疮的临床应用

目的 探讨臀部皮瓣修复骶尾部、臀部、坐骨结节部压疮的临床效果。方法 自2016年7月至2022年7月,芜湖市第二人民医院整复烧伤科收治的压疮患者20例（骶尾部9例,臀部5例,坐骨结节部6例）;分别采用臀上动脉穿支皮瓣修复5例,压疮创面大小为3 cm×4 cm～8 cm×13 cm,皮瓣切取面积为4 cm×8 cm～9 cm×18 cm;臀下动脉穿支皮瓣修复7例,压疮创面大小为2 cm×4 cm～8 cm×12 cm,皮瓣切取面积为5 cm×10 cm～12 cm×20 cm;臀大肌肌皮瓣修复8例,压疮创面大小为4 cm×4 cm～11 cm×15 cm,皮瓣切取面积为8 cm×12 cm～12 cm×20 cm。结果 20例患者皮瓣全部成活,18例患者供瓣区直接拉拢缝合,均一期愈合,2例患者皮瓣术后裂开,经2期手术修复愈合,其中1例患者缩小供瓣区后行全厚皮片移植术,术后全厚皮片成活良好;1例患者缩小供瓣区后行中厚皮片移植术,术后皮片部分成活,残留少许肉芽创面经后期换药治愈。结论 臀部皮瓣血供丰富,外形美观,不臃肿,弹性佳,耐磨性较好,抗感染能力较强,是目前修复骶尾部、臀部、坐骨结节部压...     

应用双侧臀上下动脉穿支皮瓣修复骶尾部巨大压疮

目的探讨采用双侧臀上、下动脉穿支皮瓣旋转修复骶尾部巨大压疮的临床效果。方法对8例骶尾部巨大压疮(15 cm×9 cm～18 cm×12 cm)患者,设计以双侧臀上、下动脉穿支为蒂的局部旋转皮瓣修复压疮创面,皮瓣切取面积30 cm×18 cm～45 cm×25 cm。结果所有皮瓣全部成活,其中6例切口一期愈合,2例切口延期愈合;术后随访1～3个月,压疮无复发,皮瓣弹性良好,双侧臀部基本对称。结论采用双侧臀上、下动脉穿支皮瓣旋转修复骶尾部巨大压疮,是一种简单可行的方法。     

应用个性化皮瓣修复臀骶周围深度压疮

目的探讨个性化皮瓣修复臀骶周围深度压疮的临床疗效。方法自2013年7月至2019年6月采用旋股外侧动脉降支带蒂皮瓣、臀下动脉股后皮支复合组织瓣和臀上、下动脉穿支皮瓣等手术方法修复深度压疮创面89例患者;创面涉及骶尾部38例,臀区34例,大转子区17例;创面面积为6 cm×8 cm～20 cm×28 cm。结果本组共89例患者,术后皮瓣一期愈合85例,延期愈合4例,其中2例高位截瘫患肢痉挛性瘫痪导致皮瓣裂开,经换药后愈合;2例皮瓣下血肿伴感染,再次手术后愈合。87例获随访3～24个月,平均16个月,皮瓣色泽、皮温、张力均较正常,且耐磨耐压,外观效果较满意。结论针对不同部位、不同形态的臀骶周围深度压疮创面采用皮瓣或肌皮瓣进行个性化手术修复治疗,可获得较满意的术后效果。     

腰臀穿支筋膜皮瓣移位修复骶尾部压疮

目的 总结采用腰臀穿支筋膜皮瓣移位修复骶尾部压疮的临床疗效.方法 2003年3月-2007年11月,收治7例骶尾部Ⅲ度压疮.男5例,女2例:年龄35～75岁.高位截瘫2例,双下肢瘫痪5例.溃疡范围4.2 cm×3.5 cm～10.0 cm×7.3 cm.术中采用6 cm×4 cm～11 cm×8 cm腰臀穿支筋膜皮瓣移位修复.结果 术后皮瓣均成活,供、受区切口Ⅰ期愈合.患者均获随访,随访时间6～30个月.皮瓣质地和外观良好,压疮无复发.结论 腰臀穿支筋膜皮瓣解剖位置恒定、血供丰富,手术操作简便、安全,修复创面较大,是修复骶尾部压疮较为理想的方法.     

臀上、臀下动脉穿支皮瓣的解剖学研究

目的 为了克服传统臀大肌肌皮瓣切取肌肉所带来的缺点，继承其血运好、组织量大的优点，寻找改进手术操作的解剖学基础。方法 采用5具10侧成人尸体，对臀上动脉、臀下动脉及其相应区域皮肤的穿支血管分布情况，包括主干血管、穿支血管的走行层次、数量、管径及分布、穿出位置及体表投影、相应区域神经分布情况进行大体解剖学研究。另对6例12侧成年女性双侧臀上动脉穿支分布区，应用多普勒超声血流探测仪进行穿支定位。结果 臀上动脉、臀下动脉起于髂内动脉，臀上动脉穿支分布区域集中在坐骨旁及臀大肌中部，数量约为10～15支，穿支血管的长度3～8cm，其外径约为1～1．5mm。这些穿支血管穿过臀大肌及筋膜直接供应相应区皮肤。来自腰神经背支的臀上皮神经越过髂棘在髂后上嵴外侧穿出深筋膜，向臀部走行，与血管穿支密切相邻．支配臀部皮肤感觉。在皮瓣上缘切口处注意分离直径合适的神经，与皮瓣一同切取，可与受区相应神经(如为乳房再造可与第4肋问神经)相吻合。在成人6例12侧女性患者，用多普勒超声血流探测仪进行定位，每侧可明确定位3～5支，均集中于由髂后上嵴、股骨大转子及坐骨结节所形成的三角区内，此为穿支血管的体表投影区域。结论 臀上动脉穿支血管分布区域恒定，管径粗细合适，切取该区域皮瓣，完全可以不携带肌肉，既包含了肌皮瓣血运好、组织量大的优点，又克服了切取肌肉所带来的缺点，临床应用多普勒血流探测仪进行穿支血管定位，简单可靠。切取皮瓣可同时携带臀上神经，为与受区神经吻合成为可能。由于臀下动脉穿支分布区为臀部负重部位，且臀下动脉主干与坐骨神经毗邻，因此，建议临床上尽量不采用臀下动脉穿支皮瓣。臀上动脉穿支皮瓣预期可行带蒂移植用于修复骶尾部褥疮等创面，也可成为乳房再造又一供区。     

应用双侧臀上动脉穿支岛状皮瓣修复骶尾部巨大压疮

目的：探讨应用双侧臀上动脉穿支岛状皮瓣修复骶尾部巨大压疮的手术方法和疗效。方法：11例骶尾部巨大压疮,均采用双侧臀上动脉穿支岛状皮瓣移位修复;创面范围11cm×10cm-17cm×14cm,皮瓣大小20cm×11cm-22cm×14cm。结果：11例双侧臀上动脉穿支皮瓣全部成活,压疮创面一期愈合;随访1-3年,皮瓣不显臃肿,无凹陷、感染、坏死,臀部外观均良好。结论：臀上动脉穿支密集,血供丰富,营养皮肤及皮下组织范围大,故臀上动脉穿支岛状皮瓣治疗骶尾部压疮疗效满意,而使用双侧该皮瓣则是修复骶尾部巨大压疮的最佳选择。     

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.     

Freestyle perforator-based V-Y advancement flap for reconstruction of soft tissue defects at various anatomic regions

BACKGROUND: Perforator flap surgery has gained great popularity in the last decade because surgeons can prepare freestyle flaps in anywhere on the body if they find a perforator supplied to the flap. One of the basic principles of reconstructive surgery is that superior results can be obtained for color and texture match if immediately adjacent soft tissue is used to repair a defect. V-Y advancement flaps are used successfully based on this principle, but the degree of mobility of a V-Y advancement flap is dependent on the laxity of the underlying subcutaneous tissue. This is an important disadvantage of traditional V-Y advancement flap and limits its use. METHODS: We used V-Y advancement flaps as perforator-based to overcome mobility restriction problem. The authors used 26 perforator-based V-Y advancement flaps in 24 consecutive patients for coverage of defects located at sacral (4), thigh (6), abdominal wall (3), inguinal (3), back (4), leg (2), and trochanter (2) regions. There were 14 female and 10 male patients with a mean age of 48.3 years (range, 22-70 years). RESULTS: The patients were followed up for a mean period of 14.2 months (range, 9-21 months). The size of the defects ranged from 3 x 5 cm to 15 x 20 cm. All flaps survived completely (92.4%) except 2 in which one of them had undergone total necrosis and the other had marginal necrosis. Fifteen flaps (57.6%) were elevated based on 2 perforators, 7 flaps (26.9%) were used with only one perforator, and the remaining 4 (15.5%) had 3 perforators. CONCLUSIONS: Perforator-based V-Y advancement flaps are safe and very effective for coverage of defects in which closure is impossible with a standard V-Y advancement flap. Dissection of the perforator or perforators offers remarkable excursion to the V-Y flap with minimal donor site morbidity. These axial pattern flaps can be used successfully with good esthetic and functional results at various regions of the body if there is any detectable perforator.     

肋间后动脉外侧穿支蒂皮瓣修复上肢电损伤创面

目的建立以肋间后动脉外侧穿支为血供的带蒂腹部皮瓣覆盖上肢电损伤创面的手术方法，观察其应用效果。方法应用以第7～10肋间穿支血管供养的腹部皮瓣，修复6例电损伤患者肘部、前臂、腕部、手掌部创面。皮瓣面积16．0cm×12．0cm～9．0cm×7．0cm，移植皮瓣18．21d后断蒂。观察皮瓣的成活情况及外观。结果肋间后动脉外侧穿支蒂皮瓣血供可靠，手术操作简便、耗时短。5例皮瓣移植后全部成活；1例皮瓣因切取时超过脐旁线，致远端边缘3．5cm×2．0cm部分坏死。术后外观满意。结论肋间后动脉外侧穿支蒂皮瓣适用于前臂、肘部及手部损伤创面的修复。     

Simplified and versatile use of gluteal perforator flaps for pressure sores

As a first choice for treating pressure sores, we present our experiences with gluteal perforator flaps and a simplified surgical technique. Twenty-three gluteal perforator flaps were used in 20 patients (13 males, 7 females; aged, 8-68 years) with pressure sores. The pressure sores were sacral in 16 patients, ischial in 2, and trochanteric in 2 patients. During follow-up, recurrence in the same region did not occur. Our simplified operative technique includes finding a suitable perforator with a Doppler probe (it does not matter from which mother artery), outlining the flap, dissecting the perforator with just enough length, and transposing the flap to the defect. The gluteal region has numerous perforators, and there is no need to depend on strict anatomic landmarks to detect perforator vessels or to sacrifice main arteries, as has been the case when raising gluteal perforator flaps.     

A reusable perforator-preserving gluteal artery-based rotation fasciocutaneous flap for pressure sore reconstruction

Background: Perforator‐based fasciocutaneous flaps for reconstructing pressure sores can achieve good functional results with acceptable donor site complications in the short‐term. Recurrence is a difficult issue and a major concern in plastic surgery. In this study, we introduce a reusable perforator‐preserving gluteal artery‐based rotation flap for reconstruction of pressure sores, which can be also elevated from the same incision to accommodate pressure sore recurrence. Methods: The study included 23 men and 13 women with a mean age of 59.3 (range 24–89) years. There were 24 sacral ulcers, 11 ischial ulcers, and one trochanteric ulcer. The defects ranged in size from 4 × 3 to 12 × 10 cm². Thirty‐six consecutive pressure sore patients underwent gluteal artery‐based rotation flap reconstruction. An inferior gluteal artery‐based rotation fasciocutaneous flap was raised, and the superior gluteal artery perforator was preserved in sacral sores; alternatively, a superior gluteal artery‐based rotation fasciocutaneous flap was elevated, and the inferior gluteal artery perforator was identified and dissected in ischial ulcers. Results: The mean follow‐up was 20.8 (range 0–30) months in this study. Complications included four cases of tip necrosis, three wound dehiscences, two recurrences reusing the same flap for pressure sore reconstruction, one seroma, and one patient who died on the fourth postoperative day. The complication rate was 20.8% for sacral ulcers, 54.5% for ischial wounds, and none for trochanteric ulcer. After secondary repair and reconstruction of the compromised wounds, all of the wounds healed uneventfully. Conclusions: The perforator‐preserving gluteal artery‐based rotation fasciocutaneous flap is a reliable, reusable flap that provides rich vascularity facilitating wound healing and accommodating the difficulties of pressure sore reconstruction. © 2012 Wiley Periodicals, Inc. Microsurgery, 2012.     

Giant trochanteric pressure sore: Use of a pedicled chimeric perforator flap for cover

Pressure sores are increasing in frequency commensurate with an ageing population with multi-system disorders and trauma. Numerous classic options are described for providing stable wound cover. With the burgeoning knowledge on perforator anatomy, recent approaches focus on the use of perforator-based flaps in bedsore surgery. A giant neglected trochanteric pressure sore in a paraplegic is presented. Since conventional options of reconstruction appeared remote, the massive ulcer was successfully managed by a chimeric perforator-based flap. The combined muscle and fasciocutaneous flaps were raised as separate paddles based on the anterolateral thigh perforator branches and provided stable cover without complications. Perforators allow versatility in managing complex wounds without compromising on established principles.     

臀大肌远侧穿支V-Y皮瓣修复骶部褥疮

目的探讨应用臀大肌远侧穿支V-Y皮瓣修复骶部褥疮,简化手术操作。方法2002年3月~2005年3月,对11例骶部褥疮应用臀大肌远侧穿支V-Y皮瓣修复。褥疮范围:13 cm×11 cm~18 cm×14 cm,褥疮最大直径达18 cm。其中男7例,女4例。年龄21~69岁。病程8个月~3年。手术彻底清创后,设计以褥疮外侧创缘为底部,顶在股骨大转子处的V形皮瓣,皮瓣的内侧半在臀大肌的浅面掀起,皮瓣的外侧部从臀大肌深面掀起,形成一包含外侧穿支的V形皮瓣。将皮瓣向内侧推进修复骶部创面,供区创面作V-Y缝合。结果11例骶部褥疮修复后,皮瓣全部成活。术后随访5个月~3年,双臀部对称,外形满意,除1例因其他疾病死亡外,余无褥疮复发。结论臀大肌远侧穿支V-Y皮瓣手术操作简便、血运丰富、蒂部较长、向内侧推进的幅度较大、皮瓣大及供区损害小且可直接缝合,是修复骶部较大的软组织缺损可供选择的一种方法。     

The gluteal perforator-based flap in repair of pressure sores.

The gluteal perforator-based flap is designed according to the localisation of sacral perforator vessels. These vessels penetrate the gluteus maximus muscle and reach the intrafascial and suprafascial planes, and the overlying skin forming a rich vascular plexus. The gluteal perforator-based flaps described in this paper are highly-vascularised, have minimal donor site morbidity, do not require the sacrifice of the gluteus maximus muscle and rarely lead to post-operative complications. We believe these easy-to-perform flaps might be considered as the first choice in the repair of gluteal pressure sores.     

Comparison of bacterial inoculation and transcutaneous oxygen tension in the rabbit S1 perforator and latissimus dorsi musculocutaneous flaps

Muscle and musculocutaneous flaps have been used reliably in reconstruction of soft-tissue defects for many years. Previous experimental studies have shown musculocutaneous flaps to be superior to the random pattern and fasciocutaneous flaps in the management of infected wounds. Over the past decade, perforator flaps have gained acceptance as alternative methods of reconstruction in the clinical setting that can decrease donor-site morbidity and hospital stay, and increase patient satisfaction. The authors theorized that perforator flaps may be able to handle infected wounds better than random pattern and fasciocutaneous flaps because their blood supply is essentially the same as many of their musculocutaneous counterparts. The goal of this study was to compare the S1 perforator-based skin flap and latissimus dorsi musculocutaneous flap in the dorsal flank of the rabbit with the introduction of bacteria to simulate both superficial and deep wound infection. Measurements of oxygen tension and regional perfusion index were performed on both types of flaps to ascertain their viability and capacity to heal. The authors found no statistical significance between latissimus dorsi musculocutaneous and S1 perforator flaps in the rabbit with respect to superficial and deep wound infections. The regional perfusion index was calculated for postoperative days 1, 2, and 4. No statistically significant difference between the two flaps using the regional perfusion index could be identified. Additionally, regional perfusion for both types of flaps was greater than 0.6, indicating that their capacity to heal wounds is similar.     

Application of the pedicled anterolateral thigh flap to defects from the pelvis to the knee

The blood flow and the blood perfusion of pedicled anterolateral thigh (ALT) flap was evaluated in 11 patients with skin and soft tissue defects by means of color Doppler ultrasonography and of near-infrared spectroscopy, respectively. Also, the authors assessed the ability of the pedicled perforator flap to cover the above defects. A proximally based flap was used to cover defects at the lower abdominal wall (two patients), the suprapubic area, the penis (two patients), the greater trochanter (two patients), the lateral gluteal area, and the ischial tuberosity. A distally based flap was used to cover the exposed knee joint (two patients). Near-infrared spectroscopy revealed excellent oxygen saturation and Doppler ultrasonography documented increased blood flow and decreased vascular resistance in the pedicled ALT flap, postoperatively. All flaps survived completely and the wounds healed uneventfully, resulting in excellent esthetic and functional results. The vascular anatomy of ALT flap facilitates the design of versatile pedicled flaps with tremendous vascularity, two pivot points and large arc of rotation, able to cover defects from the lower abdominal wall to the knee joint.