SGAP Flap for Reconstruction of Sacral Pressure Sores

薦部是所有褥瘡好發部位中最為常見之一，由於患者通常是長期臥床，在病情許可狀況下，手術治療不僅可以避免患者因傷口惡化造成致命的併發症，也可以為照顧者及醫療資源節省很多的人力和經濟負擔。而薦部褥瘡重建以往最常被使用的旋轉肌皮瓣，雙側V-Y前進臀大肌肌皮瓣最近已逐漸被臀動脈穿通枝皮瓣所取代，不論是旋轉肌皮瓣或雙側V-Y前進臀大肌肌皮瓣都必須切割分離臀大肌，不僅手術範圍廣泛，失血多，供應區傷害大，對於承受壓力的耐受性，也因為肌皮瓣含肌肉對於缺氧的耐受性劣於筋膜皮瓣，而術後較易復發，臀動脈穿通枝皮瓣優點在於保留完整的臀大肌功能，這對於有恢復行動能力的病人極為重要，手術切割範圍小失血少，皮瓣設計較不受限，有較佳的缺氧耐受性，而其缺點須要分離穿通枝血管莖及小心設計皮瓣，才能避免併發症。

關鍵字

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並列摘要

From August 2004 to October 2005 we underwent 13 procedures using SGAP(superior gluteal artery perforator)as pedicles by either advancement(8/13)or interpolated(5/13)flaps in reconstruction of twelve sacral ulcers in twelve patients. Three(two interpolated and one advanced flaps)of the thirteen procedures were complicated with venous congestion and hematoma, two were saved by decompression with tunnel widening and flap debulking, however the other one interpolated flap was lost post salvage and the defect needed resurfacing by a V-Y advancement SGAP flap from the opposite side. Ten of the thirteen flaps survived completely without morbidity and only one recurrence noted after an average 10 months follow-up. We found the interpolative moving of flaps and the thickness discrepancy between defects and flaps (the SGAP flaps were usually too bulky for shallow sacral ulcers)may increase the risk for torsion of pedicle and venous congestion that resulted in serious complication even flap loss.

並列關鍵字

sacral pressure ulcer ； SGAP superior gluteal artery perforator ； interpolated and advancement flap ； thickness discrepancy

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SGAP Flap for Reconstruction of Sacral Pressure Sores

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