臀部穿支皮瓣在褥疮修复中应用.docVIP

臀部穿支皮瓣在褥疮修复中应用[摘要]目的:探讨臀上或臀下穿支皮瓣修复臀部褥疮的方法及效果。方法:采用臀上或臀下穿支皮瓣修复臀部褥疮共9例。皮瓣面积为6cm×10cm～8cm×20cm,覆盖受区溃疡大小为4cm×7cm～7cm×18cm。结果:术后皮瓣全部成活,随访3个月～1年半,皮瓣质地良好,外形不臃肿,供区愈合良好。结论:臀上或臀下穿支皮瓣血运可靠,设计灵活,手术切取简便安全,保留臀大肌,供区无须植皮,是修复臀部褥疮创面的理想方法。 [关键词]臀上动脉;臀下动脉;褥疮;修复;穿支皮瓣 [中图分类号]R622[文献标识码]A[文章编号]1008-6455(2010)08-1127-03 Application of gluteal artery flap in repair of sacral bedsore ZHOU Zhong-zhi,HUANG Xin-ling,SHU Wei,CHEN Li,XIAO Ning,ZHOU Zhong-ping (Hunan Fire General Hospital of Forced Police,Changsha 410008,Hunan,China) Abstract:ObjectiveTo investigate the methods and effects of the superior and inferior gluteal artery flap in the repair of sacral bedsore.Methods The superior and inferior gluteal artery flap were used to repair the sacral bedsore in 9 cases. The area of skin flap was 6cm×10cm～8cm×20cm,the area of ulcerated area was 4cm×7cm～7cm×18cm.ResultsAll the skin flaps were survived after operation. Cases were followed up from three months to One and half a year. The texture,functions and appearance of flaps were fine,and the donor site heal well.Conclusions The superior and inferior gluteal artery flaps which have reliable blood supply and could be transferred simply and safely, is an ideal method to repair the sacral bedsore with preserve the muscle of gluteal maximums.Donor site recover well without skin grafting. Key words: superior gluteal artery; inferior gluteal artery,bedsore; repair;artery flap 褥疮(压疮,压力性溃疡)是由于大面积烧伤、脑溢血、脑外伤、脊柱损伤等原因导致长期卧床,局部组织长期受压,造成血液循环障碍,局部持续缺血、缺氧、营养不良而导致的软组织溃烂甚至坏死。褥疮容易发生在骨突部位,尤其多发生骶尾部、大转子部位和坐骨部位。由于长期负重受压、摩擦, 单纯局部换药,植皮容易出现反复溃破,经久不愈,传统的局部皮瓣和臀大肌皮瓣修复都有其不足,近年来利用臀部穿支皮瓣修复臀部褥疮,是一种较为理想的方法[1-4]。2005年6月以来,笔者利用臀上和臀下穿支皮瓣,依据创面情况,采用单叶、双叶或多叶等穿支皮瓣修复臀部褥疮9例,收到了良好的效果。 1资料和方法 1.1 临床资料:本组9例,男性5例,女性4例,年龄最大者83岁,年龄最小者34岁,平均53 岁。糖尿病患者2例。褥疮形成至整复间隔时间最长者8年,最短者5个月,最大创面为7cm×18cm,最小创面为4cm×7cm,褥疮深度达骨面。4例发生在骶尾部,3例发生在大转子部位和2例发生坐骨部。 1.2 手术方法 1.2.1 术前评估:评估患者全身情况良好,创面无急性炎症、无积脓,能耐受手术;必要时要予以输血、补充人血白蛋白等营养支持,控制血糖等。充分估计创面范围,包括潜在的溃疡和瘢痕创面。术前利用多谱勒超声血流仪测定褥疮创面周围皮肤穿