Lin Chin-Ta, Chen Shih-Yi, Chen Shyi-Gen, Tzeng Yuan-Sheng, Chang Shun-Cheng
From the Division of Plastic and Reconstructive Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
Ann Plast Surg. 2015 Jul;75(1):62-5. doi: 10.1097/SAP.0000000000000024.
Despite advances in reconstruction techniques, pressure sores continue to present a challenge to the plastic surgeon. The parasacral perforator flap is a reliable flap that preserves the entire contralateral side as a future donor site. On the ipsilateral side, the gluteal muscle itself is preserved and all flaps based on the inferior gluteal artery are still possible. We present our experience of using parasacral perforator flaps in reconstructing sacral defects.
Between August 2004 and January 2013, 19 patients with sacral defects were included in this study. All the patients had undergone surgical reconstruction of sacral defects with a parasacral perforator flap. The patients' sex, age, cause of sacral defect, flap size, flap type, numbers of perforators used, rotation angle, postoperative complications, and hospital stay were recorded.
There were 19 parasacral perforator flaps in this series. All flaps survived uneventfully except for 1 parasacral perforator flap, which failed because of methicillin-resistant Staphylococcus aureus infection. The overall flap survival rate was 95% (18/19). The mean follow-up period was 17.3 months (range, 2-24 months). The average length of hospital stay was 20.7 days (range, 9-48 days). No flap surgery-related mortality was found. Also, there was no recurrence of sacral pressure sores or infected pilonidal cysts during the follow-up period.
Perforator-based flaps have become popular in modern reconstructive surgery because of low donor-site morbidity and good preservation of muscle. Parasacral perforator flaps are durable and reliable in reconstructing sacral defects. We recommend the parasacral perforator flap as a good choice for reconstructing sacral defects.
尽管重建技术取得了进展，但压疮仍然给整形外科医生带来挑战。骶旁穿支皮瓣是一种可靠的皮瓣，可保留对侧整个部位作为未来的供区。在同侧，臀肌本身得以保留，所有基于臀下动脉的皮瓣仍然可行。我们介绍我们使用骶旁穿支皮瓣重建骶骨缺损的经验。
2004年8月至2013年1月，本研究纳入了19例骶骨缺损患者。所有患者均接受了骶旁穿支皮瓣手术重建骶骨缺损。记录患者的性别、年龄、骶骨缺损原因、皮瓣大小、皮瓣类型、使用的穿支数量、旋转角度、术后并发症及住院时间。
本系列共有19个骶旁穿支皮瓣。除1个骶旁穿支皮瓣因耐甲氧西林金黄色葡萄球菌感染失败外，所有皮瓣均顺利存活。皮瓣总体存活率为95%（18/19）。平均随访期为17.3个月（范围2 - 24个月）。平均住院时间为20.7天（范围9 - 48天）。未发现与皮瓣手术相关的死亡病例。此外，随访期间未出现骶骨压疮复发或感染性藏毛囊肿。
基于穿支的皮瓣因供区并发症少且肌肉保留良好，在现代重建手术中已变得很受欢迎。骶旁穿支皮瓣在重建骶骨缺损方面耐用且可靠。我们推荐骶旁穿支皮瓣作为重建骶骨缺损的良好选择。
