- 期刊
Flap from the Gluteal Crease for Sacral Sore Reconstruction
以臀摺皮瓣來重建薦部褥瘡
摘要
背景： 重建薦部褥瘡是整形外科醫師常見之工作，但遇到褥瘡復發或皮瓣失敗時，情況就變得複雜，對於增加重建薦部褥瘡之初級及次級的皮瓣選擇，是有必要的。 目標： 臀摺皮瓣的血流主要是來自臀下動脈，由於終端分枝及皮瓣組成的不同又可細分為三種次分類，我們嘗試用臀摺皮瓣來重建薦部褥瘡，希望能增加整形外科醫師重建薦部褥瘡的皮瓣選擇。 題材與方法： 從2005年六月至2008年五月，共有十名第四級薦部褥瘡的患者接受臀摺皮瓣重建，臀摺皮瓣為設計位置在臀摺上，以島皮瓣的方式取下，並以臀下動脈為皮瓣的血液循環來重建薦部褥瘡，平均的褥瘡缺陷大小為120平方公分（12公分乘10公分），平均的皮瓣大小為86.9平方公分（10.6公分乘8.2公分）。 結果：所有的皮瓣皆完全存活且傷口癒合的令人滿意，除了一個皮瓣失敗，次要的併發症包括兩個捐贈區的傷口裂開且須重新傷口縫合。有一個皮瓣產生暫時性的皮瓣充血但之後自發性的緩解，這些併發症都是由於麻痺性植物狀態病人的髖關節攣縮引起的張力所導致。 結論： 臀摺皮瓣是一種可信賴的皮瓣，他可成為初級重建薦部褥瘡的另類選擇，或成為拯救復發性薦部褥瘡或皮瓣壞死的皮瓣選擇，但應用在有髖關節攣縮的病人時須格外小心。
關鍵字
無資料並列摘要
Background: Sacral sore reconstruction is a common task for a plastic surgeon, but the condition becomes complicated if the sacral sore recurred or flap failed. Additional available flap is needed either for primary reconstruction or secondary reconstruction. Aim and Objectives: The flap from the gluteal crease derives blood supply from the inferior gluteal artery, but can be subcategorized into three types according to the different terminal branches and flap composition. We tried to use this flap to reconstruct the sacral sore and increase the armamentarium of a plastic surgeon. Materials and Methods: Between June 2005 and May 2008, 10 patients with stage IV sacral sores were reconstructed with flaps from the gluteal crease. The flap is designed over the gluteal crease and harvested as an island flap that is based on the inferior gluteal artery to reconstruct the sacral sore. The average defect size was 120 cm^2 (12×10 cm^2). The average flap size was 86.9 cm2 (10.6×8.2 cm2). Results: All flaps survived completely and the wound healed satisfactorily, except for one flap failure that was converted into V-Y advancement flap. Minor complications included two wound dehiscence in donor sites that required further wound closure, and one flap had temporary flap congestion that resolved spontaneously. These complications were caused by tension resulted from hip contracture in the spastic vegetable patients. Conclusion: The flap from the gluteal crease was a reliable flap that can serve as an alternative choice for primary reconstruction of the sacral sore or a secondary option for salvaging recurrent sacral sore. The flap should be used with caution in patient with hip contracture.