A Comparison of Parasacral Perforator Flaps and Superior Gluteal Artery Perforator Flaps for Sacral Defects

薦骨旁穿通支皮瓣與臀上動脈穿通支皮瓣於薦骨軟組織缺損重建之應用及比較

陳世宜(Shih-Yi Chen) ； 傅如鵬(Ju-Peng Fu) ； 曾元生(Yuan-Sheng Tzeng) ； 陳紹良(Shao-Liang Chen) ； 陳天牧(Tim-Mo Chen) ； 張舜程(Shun-Cheng Chang) ； 陳錫根(Shyi-Gen Chen)

《臺灣整形外科醫學會雜誌》 19卷3期 (2010/09) Pp. 221-229

https://doi.org/10.7096/TJTSPS.201009.0221

摘要

背景：
穿通支皮瓣因其具有較低皮瓣供給區併發症及良好的肌肉組織保存，成爲現今重建手術中受歡迎的選擇。臀部的穿通支皮瓣現已廣泛使用於薦骨軟組織缺損的重建。本文呈獻本院使用薦骨旁穿通支皮瓣與臀上動脈穿通支皮瓣於薦骨軟組織缺損重建之應用並比較其手術預後。
方法：
本研究從2003年一月至2008年八月，共有44位病人因薦骨處軟組織缺損而至本院接受薦骨旁穿通支皮瓣或臀上動脈穿通支皮瓣之重建。回顧項目包括病人的性別、年齡、內科疾病、皮瓣大小及種類、皮瓣之穿通支數目、皮瓣轉移之旋轉角度、以及兩組不同皮瓣間的成功率與併發症比較分析。
結果：
本系列共有27位病人接受臀上動脈穿通支皮瓣重建及17位病人接受薦骨旁穿通支皮瓣重建。四十例皮瓣存活良好，皮瓣存活率爲91%(40/44)，三例臀上動脈穿通支皮瓣及一例薦骨旁穿通支皮瓣因靜脈充血或術後感染而壞死。因兩組之平均皮瓣大小及皮瓣存活率皆無統計學上之差別，但薦骨旁穿通支皮瓣組因不需要臀大肌肌肉內血管分離，平均手術時間較臀上動脈穿通支皮瓣組短。
結論：
薦骨旁穿通支皮瓣與臀上動脈穿通支皮瓣皆可提供薦骨軟組織缺損良好且可靠的覆蓋。因薦骨旁穿通支皮瓣可節省手術時間且其學習曲線較短，我們建議可做爲薦骨軟組織缺損重建之另一良好選擇。

並列摘要

Background:
Perforator-based flaps have become popular in modern reconstructive surgery because of low donor site morbidity and good preservation of muscle. Gluteal perforator flaps have been used widely for reconstructing sacral defects. We present our experience of using parasacral perforator flaps or superior gluteal artery perforator (SGAP) flaps in reconstructing sacral defects and compare the surgical outcomes.
Methods:
Between January 2003 and August 2009, 44 patients with sacral defects were included in this study. All the patients had undergone surgical reconstruction of sacral defects with a parasacral perforator flap or an SGAP flap. The patients’ gender, age, medical comorbidity, flap size, flap type, number of perforator used, rotation angle, postoperative drainage amount and postoperative complications were recorded, and a comparison was done between the two groups.
Results:
There were 27 SGAP flaps and 17 parasacral perforator flaps in this series. All survived uneventfully except for three SGAP flaps and one parasacral perforator flap. The flap survival rate was 91 percent (40/44). There were no significant differences between the two groups in flap size or survival (P=0.47). The mean operation time was significantly shorter in the parasacral flap group (P=0.01).
Conclusion:
Both parasacral perforator flaps and SGAP flaps are durable and reliable in reconstructing sacral defects. By saving operation time and offering a short learning curve for the surgeon, we recommend the parasacral perforator flap as a good choice for reconstructing sacral defects.

並列關鍵字

sacral pressure sore ； pilonidal cyst ； parasacral perforator ； superior gluteal artery