Moon Suk-Ho, Choi Jang-Youn, Lee Jung-Ho, Oh Deuk-Young, Rhie Jong-Won, Ahn Sang-Tae
From the Department of Plastic and Reconstructive Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Ann Plast Surg. 2015 May;74(5):589-93. doi: 10.1097/SAP.0b013e3182a1e6c4.
Skin and soft tissue defects in the lumbosacral area are commonly encountered in the field of reconstructive surgery, and it is well documented that the superior gluteal artery perforator (SGAP) flap provides excellent coverage of these defects. In this article, we describe our experience using a modified version of the SGAP propeller flap, in which the distal redundant portion of an elevated SGAP flap is deepithelialized, thereby maximizing the effect of the soft tissue augmentation. Thirteen patients with lumbosacral soft tissue defects treated between May 2010 and June 2012 were included in this study. The wound causes were pressure ulcer (n = 9), pseudomeningocele (n = 2), and hardware exposure (n = 2). In all patients, an elevated SGAP flap was rotated 180 degrees over the defect area and the extra distal portion of the flap was deepithelialized and used as a soft tissue filler or tamponade. During the follow-up period (mean, 26 months), 12 of 13 flaps survived completely. One flap was totally necrosed due to progressive venous congestion and was reconstructed with local advancement flaps. No further complications were noted. Because of the redundancy and pliability of the tissue in the gluteal area, a flap relatively wider or longer than the defect can be elevated safely. Hence, the redundant tissue volume can be tucked inside to facilitate soft tissue augmentation of the area. We propose that the deepithelialized version of the SGAP propeller flap is an effective option for the reconstruction of various lumbosacral soft tissue defects because it offers thick and healthy soft tissue from a distant site to the defect areas.
腰骶部皮肤和软组织缺损在重建外科领域较为常见，有充分文献记载臀上动脉穿支（SGAP）皮瓣能很好地覆盖这些缺损。在本文中，我们描述了使用改良版SGAP推进皮瓣的经验，即对掀起的SGAP皮瓣远端多余部分进行去上皮化处理，从而最大限度地增强软组织填充效果。本研究纳入了2010年5月至2012年6月间接受治疗的13例腰骶部软组织缺损患者。伤口病因包括压疮（n = 9）、假性脑脊膜膨出（n = 2）和内固定物外露（n = 2）。所有患者中，掀起的SGAP皮瓣在缺损区域旋转180度，皮瓣远端多余部分进行去上皮化处理后用作软组织填充物或填塞物。在随访期（平均26个月），13例皮瓣中有12例完全存活。1例皮瓣因进行性静脉淤血完全坏死，采用局部推进皮瓣进行了重建。未发现进一步并发症。由于臀部区域组织的冗余性和柔韧性，可以安全地掀起相对比缺损更宽或更长的皮瓣。因此，多余的组织量可向内折叠以促进该区域的软组织填充。我们认为，去上皮化版的SGAP推进皮瓣是重建各种腰骶部软组织缺损的有效选择，因为它能从远处为缺损区域提供厚实且健康的软组织。
