双侧反向臀上动脉远侧穿支V-Y推进筋膜皮瓣修复骶部巨大褥疮(1)
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[摘要]目的：笔者设计了一种双侧反向臀上动脉远侧穿支V-Y推进筋膜皮瓣，关闭巨大骶部溃疡，以增加皮瓣推进量，避免臀大肌功能性缺损。方法：清创后V-Y推进皮瓣标记于双侧臀部。在缺损近侧掀起筋膜皮瓣，在远侧臀大肌肌肉附件里保留臀上动脉远侧穿支，直至获得足够的皮瓣前移。结果：用此方法治疗15个直径7～15cm的骶部褥疮的患者，没有出现皮瓣坏死和溃疡复发，91%的皮瓣Ⅰ期愈合。结论：此技术使皮瓣推进量增加，皮瓣存活可靠，并保留了双侧臀部和臀大肌功能。
[关键词]骶部褥疮；穿支皮瓣；V-Y筋膜皮瓣
1008-6455(2012)05-0722-02
Reconstruction of large sacral pressure ulcers with the double-opposing distal perforating superior gluteal arteries-based fasciocutaneous V-Y advancement flap
ZHANG Zhi-hong1,LI Wen-zhi1,MA Yong-guang2
(1.Department of Plastic Surgery and Laser Medcine,Beijing Anzhen Hospital,Capital University of Medical Sciences,Beijing 100029,China; 2.Department of Plastic and Cosmetic Surgery,The Third Hospital,Peking University,Beijing 100191,China)
Abstract: Objective We designed a double-opposing distal perforator-based fasciocutaneous V-Y advancement flap method for closing a large sacral pressure ulcer. The purposes of our method were to obtain sufficient advancement and to avoid a functional deficit of the gluteus maximus muscle. Methods After debriderment, the V-Y advancement flap is marked on the bilateral buttock. A fasciocutaneous flap is elevated from the medial part, preserving the distal perforating superior gluteal arteries in the distal muscular attachment of the gluteus maximus muscle until sufficient advancement of the flap is obtained. Results Fifteen patients with sacral pressure defects between 7～15 cm in diameter were treated using this surgical procedure. The results showed no flap necrosis and recurrence in any patient，and 91% percent of the flaps healed primarily. Conclusions The present technique accomplishes remarkable excursion of the bilateral V-Y fasciocutaneous flap, with high flap reliability and preservation of the contralateral buttock as well as gluteus maximus muscle function.
Key words: sacral pressure ulcers; perforator-based flap; V-Y fasciocutaneous flap
褥疮常使整形医生面临重建难题，因为患者老龄化，全身状况差，常常卧床或瘫痪，重建后伤口愈合差。而且，即使是好的外科修复技术，复发率仍高达20%～30%[1]。因此考虑到溃疡复发，需注意皮瓣的设计和选择。骶部是最常见的褥疮发生部位，而臀部皮瓣是重建骶部褥疮缺损最可靠和明确的方法[2]。由于组织血供差或皮瓣张力大 ......
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