Dumurgier C, Lantieri L, Rougereau G, Pujol G
Service de Chirurgie et de Paraplégie traumatique, Institution Nationale des Invalides, Paris.
Ann Chir Plast Esthet. 1991;36(2):125-31.
The authors report 24 cases treated with an gluteus maximus musculocutaneous flap. The gluteus maximus is generally used as a VY flap. Our technique uses the superior part of the muscle with the overlying skin as a rotation flap. The upper part of the muscle is supplied by the superior gluteal artery. A good knowledge of the anatomy makes this flap easy to perform. The skin part of the flap is drawn over the trochanter. It is generally a 8 cm diameter circle. We then create a subcutaneous tunnel to prepare the rotation. The muscle is then freed from its lateral origin. The separation from the gluteus medius is made by blunt dissection and the superior gluteal artery can then be seen. The myocutaneous flap can now be raised and transferred to the defect. This flap has, in our experience, many advantages especially in paraplegic patients: large skin defects can be covered with a single flap, the perisacral skin is free of any scar, the lower part of the muscle can still be used to cover ischial ulcers. Since 1987 we have treated 24 patients with good results. The reliability and the great technical simplicity makes us think that the superior gluteus maximus musculocutaneous island flap is optimal for the coverage of sacral pressure sores.
作者报告了24例采用臀大肌肌皮瓣治疗的病例。臀大肌通常用作VY瓣。我们的技术是将肌肉的上部分及其上方的皮肤作为旋转瓣使用。肌肉的上部分由臀上动脉供血。对解剖结构的充分了解使该皮瓣易于操作。皮瓣的皮肤部分覆盖大转子。通常是一个直径8厘米的圆形。然后我们创建一个皮下隧道以准备旋转。然后将肌肉从其外侧起点游离。通过钝性分离与臀中肌分离，然后可以看到臀上动脉。现在可以掀起肌皮瓣并转移至缺损处。根据我们的经验，该皮瓣有许多优点，尤其是对于截瘫患者：单个皮瓣即可覆盖大面积皮肤缺损，骶周皮肤无任何瘢痕，肌肉下部仍可用于覆盖坐骨溃疡。自1987年以来，我们已治疗24例患者，效果良好。其可靠性和极高的技术简便性使我们认为臀大肌上部肌皮岛状瓣是覆盖骶部压疮的最佳选择。
