改良腰动脉筋膜皮瓣修复腰骶尾部软组织深度缺损

目的探讨应用改良腰动脉筋膜皮瓣修复腰骶尾部软组织深度缺损的手术方法及临床效果。方法 2006年2月至2010年6月收治16例腰骶尾部软组织深度缺损患者,缺损范围8.0cm×7.0cm～21.0cm×19.0cm。经创面处理后,行全麻或硬膜外麻醉,根据缺损部位及大小,设计以改良的对侧腰动脉后穿支为血管蒂的轴型筋膜皮瓣进行转移修复手术。术后3～5d拔除负压引流,10d间断拆线,12d全部拆除缝线。结果 16例皮瓣全部成活,其中2例创缘延迟愈合。术后随访1～4年,局部外形和功能恢复满意。结论改良的腰动脉筋膜皮瓣切取面积大,血供可靠,手术操作简单,容易掌握,用于修复腰骶尾部软组织深度缺损是一种较好的方法。

Improved lumbar artery fasciocutaneous flap for repairing deep defect of the lumbar and sacrococcygeal soft tissue

Objective To explore the surgical techniques and clinical effect of improved lumbar artery fasciocutaneous flap for repairing deep defect of lumbar and sacrococcygeal soft tissue.Methods From February 2006 to June 2010,the improved lumbar artery fasciocutaneous flap prosthesis were performed in 16 patients with deep defect of the lumbar and sacrococcygeal soft tissue(ranged from 8.0 cm × 7.0 cm to 21.0 cm × 19.0 cm).The general or peridural anesthesia was applied to the operation.After treatment of the surface of wound,the improved axial fasciocutaneous flap which using the posterior perforating branch of contralateral lumbar artery as vascular pedicle was designed according to the position and size of the defect and transferred to the surface of wound to repair the defect.The vacuum drainage-tube was extracted 3-5 days after operation;the sutures were interruptedly removed 10 days and completely removed 12 days after operation.Results The flaps were all survived in 16 cases,and the healing of wound margin was delayed in 2 cases of them.All cases were followed up for 1-4 years.The focal contour and function were recovered satisfactorily.Conclusions Improved lumbar artery fasciocutaneous flap has the advantages of bigger incisional area,reliable blood supply,simple procedure techniques and easy to master,therefore it is a better method for repairing deep defect of lumbar and sacrococcygeal soft tissue.