The Inferior Gluteal Thigh Flap in Repairing Ischial, Trochanteric and Perineal Chronic Wounds

應用下腎股皮瓣於坐骨，股骨大轉子區及會陰部慢性傷口修補

鄭泰如(Tai-Ju Cheng) ； 陳志成(Chih-Cheng Chen) ； 簡守信(Sou-Hsin Chien) ； 陳明庭(Ming-Ting Chen)

《中華民國重建整形外科醫學會雜誌》 2卷1期 (1993/03) Pp. 9-17

https://doi.org/10.7096/JPRSA.199303.0009

摘要

褥瘡的處理一直是重建整形外科醫師的一項重要課題及挑戰。雖然外科手術方式及技術在最近有所進步，但由於脊椎外傷處理的進步及高齡人口的增加，褥瘡的患例也有增加的趨勢。儘管初步修補的成果令人滿意，既存的神經障礙（脊髓損傷）或意識狀況不清（老年性痴呆或腦血管病變後遺症）都使得這些患者處於長期臥床及營養狀況不佳的狀態，褥瘡的再發(recurrence)也因此成了他（她）們一生中必須面對的問題。Dr. Hurwitz在1981所發表的下臀股皮瓣(inferior geuteal thigh flap)是利用下臀動脈 (inferior gluteal artery)為血管莖(vascular pedicle)的軸向皮瓣(axial pattern flap)由於其筋皮瓣的特牲(fasciocutaneous nature)，它並不隨時間而萎縮。更由於其應用上不傷及鄰近其他肌皮瓣的血流供應，因此面對褥瘡的再發，我們仍有許多的區域性皮瓣可用以修補。近十年來，它已被多數整形重建外科醫師接受為區域性缺損重建的優先選擇。
自1988年起，我們也開始應用此一皮瓣於坐骨粗隆或股骨大轉子區褥瘡患者的重建。九例患者中，術後除兩例有輕微傷口分離(minor wound breakdown)外，其他均癒合良好。追蹤期間由三個月至兩年半並無再發患例。以島形方式(island fashion flap)設計的皮瓣在臨床應用上結果更令人滿意。

並列摘要

Management of pressure sores remains to be one of the most difficult challange to the reconstructive plastic surgeons, with recurrence being still inevitable in spite of the improved technique and availability of many surgical modalities. Since its first report by D.J. Hurwitz et al in 1981, the inferior gluteal thigh flap has soon gained wide acceptance by the plastic surgeons as a good, and even the first choice flap in covering the buttock and perineal wounds. From late 1988, nine flaps were used, five for the ischial ulcers, three for the greater trochanteric ulcers and one for perineal defect. Post-operatively, there is no flap failure with only two cases of minor wound disruption which healed smoothly under conservative wound care. During the follow-up period from 3 months to two and a half years, there is no recurrence up to date. We believe that this is a reliable and durable flap in regional complex defect reconstruction.

並列關鍵字

pressure sore ； inferior gluteal thigh flap