Ichioka Shigeru, Okabe Katsuyuki, Tsuji Shinsaku, Ohura Norihiko, Nakatsuka Takashi
Department of Plastic and Reconstructive Surgery, Saitama Medical School, Japan.
Plast Reconstr Surg. 2004 Sep 15;114(4):906-9. doi: 10.1097/01.prs.0000133167.81269.40.
Although the gluteal V-Y advancement flap has been recognized as the most reliable method for management of sacral pressure ulcers, its limited mobility has been a challenging problem. The authors present a new modification of the V-Y advancement flap to overcome the problem. After débridement, a large triangle is designed to create a V-Yadvancement flap on the unilateral buttock and the medial half is elevated as a fasciocutaneous flap, preserving the distal perforators in the muscular attachment. Then an arc-shaped incision is made in the gluteus maximus muscle along with the lateral edge of the triangular flap. The split muscle is elevated at a depth above the deeper fascia until sufficient advancement of the flap is obtained. This full-thickness elevation of the gluteus maximus muscle from the distal (lateral) side avoids the impairment of perforators or their mother vessels and achieves great advancement. Thirty-one patients with sacral pressure defects larger than 8 cm in diameter were treated using this surgical procedure. Overall, 93.5 percent of the flaps (29 of 31) healed primarily. The largest defect that was closed with a unilateral flap was 16 cm in diameter. The present technique accomplishes remarkable excursion of the unilateral V-Y fasciocutaneous flap, with high flap reliability and preservation of the contralateral buttock as well as gluteus maximus muscle function.
尽管臀大肌V-Y推进皮瓣已被公认为是治疗骶尾部压疮最可靠的方法，但其活动度有限一直是个具有挑战性的问题。作者提出了一种V-Y推进皮瓣的新改良方法来解决这一问题。清创后，设计一个大三角形在单侧臀部形成一个V-Y推进皮瓣，内侧半部分作为筋膜皮瓣掀起，保留肌肉附着处的远端穿支。然后在臀大肌上沿着三角形皮瓣的外侧边缘做一个弧形切口。将劈开的肌肉在深筋膜上方的深度掀起，直到皮瓣获得足够的推进。从远端（外侧）对臀大肌进行全层掀起可避免穿支或其母血管受损，并实现大幅度推进。31例骶尾部直径大于8 cm的压疮缺损患者采用该手术方法治疗。总体而言，93.5%的皮瓣（31例中的29例）一期愈合。用单侧皮瓣封闭的最大缺损直径为16 cm。目前的技术实现了单侧V-Y筋膜皮瓣的显著移动，皮瓣可靠性高，对侧臀部及臀大肌功能得以保留。
