Division of Plastic and Reconstructive Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
Division of Plastic and Reconstructive Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
J Plast Reconstr Aesthet Surg. 2014 Apr;67(4):526-32. doi: 10.1016/j.bjps.2013.12.031. Epub 2013 Dec 31.
Despite advances in reconstruction techniques, the treatment of sacral sores remains challenging to plastic surgeons. The superior gluteal artery perforator (SGAP) flap is reliable and preserves the entire contralateral side as a future donor site. The ipsilateral gluteal muscle is preserved, and the inferior gluteal artery flaps are viable. However, dissection of the perforator is tedious and may compromise the perforator vessels.
Between April 2003 and March 2013, we performed two modified flap-harvesting techniques: a rotational and a tunnel method, with only a short pedicle dissection to cover 30 sacral defects. Patient characteristics including sex, age, cause of sacral defect, flap size, perforator number, use and postoperative complications were recorded.
All flaps survived except two, which developed partial flap necrosis and were finally treated by contralateral V-Y advancement flap coverage. The mean follow-up period was 14.8 months (range, 3-24 months). No flap surgery-related mortality or recurrence of sacral pressure sores or infected pilonidal cysts were noted.
Perforator-based flaps have become popular in modern reconstructive surgery because of low donor-site morbidity and good preservation of muscle. The advantages of our modification procedure include shorter operative time, lesser bleeding and lesser pedicle trauma, which make the SGAP flaps an excellent choice for sacral sore coverage.
尽管重建技术有所进步，但对整形外科医生来说，治疗骶部褥疮仍然具有挑战性。臀上动脉穿支皮瓣（SGAP）是可靠的，可保留整个对侧作为未来的供体部位。保留了同侧臀肌，且臀下动脉皮瓣仍然可行。但是，穿支的解剖较为繁琐，可能会损伤穿支血管。
在 2003 年 4 月至 2013 年 3 月期间，我们采用了两种改良的皮瓣采集技术：旋转和隧道方法，仅进行短蒂解剖以覆盖 30 个骶部缺损。记录患者特征，包括性别、年龄、骶部缺损原因、皮瓣大小、穿支数量、使用情况以及术后并发症。
除了两个皮瓣出现部分坏死，最终采用对侧 V-Y 推进皮瓣覆盖治疗外，所有皮瓣均存活。平均随访时间为 14.8 个月（范围为 3-24 个月）。未发生与皮瓣手术相关的死亡或骶部褥疮复发或感染性藏毛窦。
基于穿支的皮瓣在现代重建手术中越来越受欢迎，因为其供区并发症发生率低，且能很好地保留肌肉。我们改良手术的优点包括手术时间更短、出血量更少、蒂部创伤更小，这使得 SGAP 皮瓣成为骶部褥疮覆盖的绝佳选择。
