岛状臀大肌肌皮瓣在臀部软组织缺损修复中的应用

目的：探讨岛状臀大肌肌皮瓣在臀部软组织缺损尤其是骶尾部褥疮修复中的应用。方法：以臀大肌臀上动脉穿出点为旋转轴,利用臀上动脉和臀下动脉交通支所在的臀大肌外缘肌为蒂,以旋转点至缺损区最近点为肌皮瓣蒂长度,根据缺损部位及大小进行肌皮瓣设计,形成岛状肌皮瓣,肌皮瓣面积稍大于缺损区创面。蒂部仅含臀大肌外缘肌肉,宽度1.5～2.0cm。沿设计线切开皮肤找到臀大肌臀上动脉穿出点及臀大肌外缘,向远端解剖,在臀大肌下形成的岛状皮瓣,通过皮下隧道将肌皮瓣转移到缺损区,逐层缝合切口。供区视大小可行直接拉拢缝合或邻近皮瓣转移或植皮修复。结果：应用岛状臀大肌肌皮瓣修复臀部软组织缺损7例,术后肌皮瓣全部成活,被修复处色泽、厚度及外形均满意。结论：岛状臀大肌肌皮瓣血供丰富,血管恒定,抗感染能力强,切取及转移方便,是修复臀部软组织缺损尤其是骶尾部褥疮的理想肌皮瓣。

Island gluteus maximus musculocutaneous flap for repairing the haunch soft tissue defect

Objective To explore the application of island gluteus maximus musculocutaneous flap in repairing the haunch soft tissue defect expecially sacroiliac tissue effect.Methods The rotation point was located at superior gluteal artery of gluteus maximus,the flap pedicle included lateral gluteus maximus and communicating branch of superior gluteal artery and inferior gluteal artery.The distance between the rotation point and subterminal borde of the defect was the length of the muscular flap,the island flap was contrived depending on size and location of the defect.The width of flap was slightly larger than the defect.The pedicle only contained outer gluteus maximus muscle,the width of pedicel was 1.5～2cm.The flap was cut down from the starting point of superior gluteal artery in gluteus maximus to the lateral borde of gluteus maximus.The flap was transferred to the defect through the tunnel between the pedicle and defect.The wounds at donor sites were closed directly or with skin graft or local flaps.Results 7 cases were treated.All the maximus musculocutaneous flaps survived with good texture,color and thickness.Conclusions The island gluteus maximus musculocutaneous flap is an ideal flap for the haunch soft tissue defect expecially sacroiliac tissue effect with reliable blood supply,permanent blood vessel and powerful anti-infection capability.It is easily performed and very practical.