臀部自由穿支皮瓣治疗骶尾部Ⅳ度压疮

摘要

Objective To investigate the design of free perforator flap,and the efficacy of utilizing perforator flaps for Ⅳ degree Ischia-sacral ulcer treatment.Methods From January 2010 to October 2016,18 patients with Ⅳ degree ischia-sacral ulcer were treated.The surface area of the sacral tail ranged from 4 cm×5 cm to 8 cm × 12 cm.Doppler sonography was used to detect potential perforator.All defects were repaired with free perforator flaps,designed based on the size and shape of the wound.The flap size ranged from 6 cm× 11 cm to 9 cm× 15 cm.Results One perforator flap went dehiscence after surgery,repaired by V-Y flap.All the rest of perforator flaps survived well,after 3-24 months follow-up.Flap texture and appearance was good,no ulcer reoccurred.Conclusions The free perforator flap is a simple technique.It does not need to tracethe trunk of vessels,and it does not cause major morbidities to the buttocks.Therefore,it is one of the ideal ways to repair Ⅳ degree Ischia-sacral ulcer.%目的 探讨采用臀部自由穿支皮瓣修复骶尾部Ⅳ度压疮的效果.方法 2010年1月至2016年10月,遵义医学院附属医院烧伤整形外科收治骶尾部压疮患者18例,男14例,女4例,年龄16～68岁.骶尾部创面面积为4 cm×5 cm～8 cm×12 cm,应用多普勒超声血流探测仪探测穿支血管穿出点,根据创面大小、形状设计切取臀部自由穿支皮瓣修复,皮瓣面积为6cm×11 cm～9cm×15 cm.结果 术后1例皮瓣裂开,创面再次形成,经再次手术行穿支皮瓣V-Y皮瓣推进修复;余17例皮瓣全部成活,随访3～24个月,皮瓣质地良好,外形不臃肿,无再次溃疡发生.结论 臀部自由穿支皮瓣设计简单,不需追踪主干血管,手术切取简便,不破坏臀大肌,是修复骶尾部Ⅳ度压疮创面的理想方法之一.