股深动脉第1穿动脉穿支皮瓣修复臀股部IV期压疮疗效

doi:10.13418/j.issn.1001-165x.2021.03.019

摘要/Abstract

摘要： 目的　探讨应用股深动脉第1穿动脉穿支皮瓣修复臀股部IV期压疮的可行性。方法　2016年1月至2019年2月，本院手足创伤骨科收治9例臀股部IV期压疮患者，男3例，女6例，年龄26~68岁，平均46岁。截瘫原因：高处坠落伤4例，车祸伤3例，脑梗塞2例。清创后创面面积8 cm×5 cm~18 cm×9 cm。根据创面形状、大小及位置设计股深动脉第1穿动脉穿支皮瓣修复压疮创面，皮瓣面积为10 cm×7 cm~20 cm×10 cm。结果　所有皮瓣成活，其中2例术后局部渗液较多，经积极保守换药治疗后，皮瓣恢复良好。9例获得6~24月随访，平均13月，皮瓣色泽良好，质地柔软，不影响日常生活，压疮未见复发。结论　股深动脉第1穿动脉穿支皮瓣操作简便，血供可靠，可供组织量较多，是修复臀股部IV期压疮的较好选择。

关键词: 股深动脉, 　穿支皮瓣, 　软组织缺损, 　压疮

Abstract: Objective　To investigate the feasibility of the perforator flap based on the first perforating branch of profunda femoral artery in reconstruction of patients with IV degree pressure ulcers in the region of buttock and thigh.　Methods　From January 2016 to February 2019, nine patients with IV degree pressure ulcers in the region of buttock and thigh were admitted to the department of Trauma and Orthopaedics, the Second people's Hospital of Xining city, including 3 males and 6 females, aged from 26~68 years, with an average age of 46 years. The causes of paraplegia were fall injury in 4 cases, traffic accident injury in 3 cases and cerebral infarction in 2 cases. After debridement, the wound area was 8 cm×5 cm~18 cm×9 cm. According to the shape, size and location of the wound, the perforator flap was designed to repair the pressure ulcers wound based on the first perforating branch of profunda femoral artery. The flap area was 10 cm×7 cm~20 cm×10 cm.　 Results　All flaps survived completely, including 2 cases with more local inflammatory exudates, and the flap recovered well after active conservative treating. 9 cases were followed up for 6 to 24 months, with an average of 13 months. The skin flap was good in color, soft in texture, and it did not affect daily life. No recurrence of pressure ulcers was found.　Conclusions　The perforator flap based on the first perforating branch of profunda femoral artery is easy to operate, reliable in blood supply and large amount of tissue supply. It is a better choice for the repair of patients with IV degree pressure sore in the region of buttock and thigh.

Key words: Profunda femoral artery, 　Perforator flap, 　Soft tissue defect, 　Pressure ulcers

中图分类号:

R616.2

邓长华, 孔繁福, 伍真, 聂萌, 刘超. 股深动脉第1穿动脉穿支皮瓣修复臀股部IV期压疮疗效[J]. 中国临床解剖学杂志, 2021, 39(3): 351-354.

Deng Changhua, Kong Fanfu, Wu Zhen, Nie Meng, Liu Chao. Clinical application of the perforator flap based on the first perforating branch of profunda femoral artery in reconstruction of patients with IV degree pressure ulcers in the region of buttock and thigh[J]. Chinese Journal of Clinical Anatomy, 2021, 39(3): 351-354.

参考文献 19

[1]	Haddad K, Hunsinger V, Obadia D, et al. Breast reconstruction with profunda artery perforator flap: a prospective study of 30 consecutive cases[J]. Ann Chir Plast Esthet, 2016, 61(3): 169-176. DOI: 10.1016/j.anplas.2016.02.004.
[2]	宋达疆, 毛煌兴, 李赞, 等. 股深动脉穿支皮瓣在乳房重建的应用[J]. 中华整形外科杂志, 2017, 33(6): 412-416. DOI: 10.3760/cma.j.issn.1009-4598.2017.06.003.
[3]	唐举玉, 贺继强, 吴攀峰, 等. 股深动脉第3穿动脉穿支皮瓣修复下肢软组织缺损[J]. 中华显微外科杂志, 2019, 42(2): 146-149. DOI: 10.3760/cma.j.issn.1001-2036.2019.02.011.
[4]	宋达疆, 李赞, 周晓, 等. 不同形式游离股深动脉蒂嵌合穿支肌皮瓣修复舌癌术后缺损的疗效观察[J]. 中国修复重建外科杂志, 2017, 31(6): 696-701. DOI:10.7507/1002-1892.201701045.
[5]	Ito R, Huang JJ, Wu JCW, et al. The versatility of profunda femoral artery perforator flap for oncological reconstruction after cancer resection-Clinical cases and review of literature[J]. J Surg Oncol, 2016, 114(2): 193-201. DOI: 10.1002/jso.24294.
[6]	Gebert L, Boucher F, Lari A, et al. Fasciocutaneous flap reliable by deep femoral artery perforator for the treatment of ischial pressure ulcers[J]. Ann Chir Plast Esthet, 2018,63(2): 148-154. DOI: 10.1016/j.anplas.2017.07.002.
[7]	Kim CM, Yun IS, Lee DW, et al. Treatment of ischial pressure sores with both profunda femoris artery perforator flaps and muscle flaps[J]. Arch Plast Surg, 2014, 41(4): 387-393. DOI: 10.5999/aps.2014.41.4.387.
[8]	Lee SS, Huang SH, Chen MC, et al. Management of recurrent ischial pressure sore with gracilis muscle flap and V-Y profunda femoris artery perforator-based flap[J]. J Plast Reconstr Aesthet Surg, 2009, 62(10): 1339-1346. DOI: 10.1016/j.bjps.2007.12.092.
[9]	苏卫国, 李德平, 邢培朋, 等. 穿支皮瓣联合肌瓣修复老年患者坐骨结节Ⅳ期压疮的效果[J]. 中华烧伤杂志, 2017, 33(9): 545-549. DOI: 10.3760/cma.j.issn.1009-2587.2017.09.004.
[10]	戴开宇, 胡斯旺, 梅劲, 等．股后区主要穿支的形态学分析与皮瓣设计[J]．中国临床解剖学杂志, 2006, 24(2): 247-250. DOI: 10.3969/j.issn.1001-165X.2006.03.007.
[11]	卿黎明, 贺继强, 唐举玉, 等. 基于活体造影数据的股深动脉穿动脉穿支血管的数字解剖学研究[J]. 中国临床解剖学杂志, 2016, 34(1): 12-15. DOI: 10.13418/j.issn.1001-165x.2016.01.004.
[12]	王剑利, 王根, 赵刚, 等. 游离股后侧穿支动脉皮瓣的解剖学研究及临床应用[J]. 中华显微外科杂志, 2013, 36(1): 7-10. DOI: 10.3760/cma.j.issn.1001-2036.2013.01.003.
[13]	Sur YJ, Morsy M, Mohan AT, et al. The first perforating branch of the deep femoral artery: a reliable recipient vessel for vascularized fibular grafts: an anatomical study[J]. J Plast Reconstr Aesthet Surg, 2016, 69(3): 351-358. DOI: 10.1016/j.bjps.2015.10.024.
[14]	高英茂. 人体解剖学名词. 2版[M]. 北京: 科学出版社, 2014: 226-227.
[15]	卢伯洋. 股深动脉第一穿动脉游离皮瓣的应用解剖学研究[D]. 长春: 吉林大学, 2010.
[16]	傅荣, 游晓波, 杜丽平. 臀部穿支皮瓣结合负压封闭引流治疗骶尾部褥疮[J]. 中华显微外科杂志, 2012, 35(3): 236-237. DOI: 10.3760/cma.j.issn.1001-2036.2012.03.024.
[17]	周忠志, 黄新灵, 熊武, 等. 不同类型皮瓣用于修复臀骶部深度压疮手术方式选择[J]. 中国美容医学, 2016, 25(5): 28-32. CNKI: SUN:MRYX.0.2016-05-013.
[18]	张楠, 洪雷, 张喜, 等. 臀上动脉联合股深动脉第1穿动脉穿支皮瓣修复股骨大转子压疮11例[J]. 中华烧伤杂志, 2015, 31(2): 145-146.
[19]	贺继强, 唐举玉. 股深动脉穿动脉穿支皮瓣的解剖及临床应用进展[J]. 中国临床解剖学杂志, 2017, 35(4): 475-477. DOI: 10.13418/j.issn.1001-165x.2017.04.027.