以臀上动脉浅支穿支血管为蒂分叶皮瓣修复骶尾部软组织缺损

目的探讨一种安全、有效、快速修复骶尾部软组织缺损和/或伴骨外露的方法。方法2003年2月～2006年4月,应用臀上动脉浅支穿支血管为蒂分叶皮瓣移位修复骶尾部巨大褥疮及软组织缺损6例。男4例,女2例,年龄28～67岁。骶尾部软组织缺损范围为15cm×12cm～25cm×20cm,平均20cm×16cm;褥疮5例,肿瘤1例;按褥疮分度度3例,度3例;病程3周～20年。切取分叶皮瓣范围为18cm×15cm～30cm×25cm。结果术后6例移位皮瓣均成活,其中5例切口期愈合,1例皮瓣周缘皮肤少量缺血、坏死,经间断换药32d后期愈合。随访2～38个月,平均19.3个月,分叶皮瓣生长良好,褥疮无复发,臀大肌保留良好伸髋功能。结论带臀上动脉浅支穿支血管为蒂分叶皮瓣是修复骶尾部软组织缺损和/或伴骨外露的一种有效方法,具有操作简便、皮瓣血运好、并发症少、成功率高等优点。

AN EFFECT OF MULTI-ISLAND FLAP WITH SHALLOW BRANCH OF GLUTEUS UPPER ARTERY ON REPAIR OF SACRUM SOFT TISSUE DEFECT

OBJECTIVE: To explore a safe, highly-efficient and rapid approach to the repair of the sacrum soft tissue defect and/or partial exposure of the bone. METHODS: From February 2003 to April 2006, 6 patients (4 males, 2 femals; aged 28-67 years) with the sacrum soft tissue defect were surgically treated by the multi-island flap with shallow branches of the gluteus upper artery. The soft tissue defects ranged in area from 15 cm x 12 cm to 25 cm x 20 cm, averaged 20 cm x 16 cm. The obtained flaps ranged in area from 18 cm x 15 cm to 30 cm x 25 cm. Of the patients, 5 had a sacral ulcer (Grade III in 3 patients, Grade IV in 2) and 1 had a tumor, with their illness course from 3 weeks to 20 years. RESULTS: All the flaps survived completely in the 6 patients, in whom 5 had an incision healing of the first intention, and the remaining 1 had a healing of the second intention 32 days after the treatment for the minor ischemia and necrosis at the edges of the flap. The follow-up for 2-38 months (average, 19.3 months) revealed that all the flaps grew well with no recurrence of the sacral ulcer. CONCLUSION: The surgical treatment with the multi-island flap with shallow branches of the gluteus upper artery is a safe, highly-efficient and rapid approach to repair of the sacrum soft tissue defect and/or partial exposure of the bone. This kind of treatment has advantages of simpler procedures, better blood circulation of the flap, fewer complications, and higher success rates.