Rubayi S, Doyle B S
Department of Surgery, University of Southern California, Downey, USA.
Plast Reconstr Surg. 1995 Nov;96(6):1366-71. doi: 10.1097/00006534-199511000-00020.
We describe a modified technique using the gluteus maximum muscle as a splitting myocutaneous flap to close specifically low sacral and coccygeal pressure ulcers. Twenty-eight patients with sacral or coccygeal stage IV pressure ulcers (average size 4 x 4 cm) underwent a gluteus maximus muscle-splitting myocutaneous flap when conservative treatment failed to heal the ulcer. Twenty-seven of the 28 patients had complete healing of the pressure ulcer site at an average follow-up of 15 months (range 2 to 40 months). Complications occurred in 7 patients, requiring revision of the flap in 2 patients. The advantages of this technique include reduced blood loss, preservation of most of the gluteus maximus for future use, and retained function of the gluteus maximus for stair climbing and single-limb support in the ambulatory patient. We recommend the gluteus maximus muscle-splitting myocutaneous flap as the procedure of choice for closure of small low sacral or coccygeal ulcers in both the ambulatory and nonambulatory patient.
我们描述了一种改良技术，即使用臀大肌作为劈开式肌皮瓣，专门用于闭合低位骶尾部压疮。28例患有骶尾部IV期压疮（平均大小为4×4厘米）的患者，在保守治疗未能治愈溃疡时，接受了臀大肌劈开式肌皮瓣手术。28例患者中有27例在平均15个月（范围为2至40个月）的随访中压疮部位完全愈合。7例患者出现并发症，其中2例需要对皮瓣进行修复。该技术的优点包括减少失血、保留大部分臀大肌以备将来使用，以及保留臀大肌功能以便行走患者爬楼梯和单腿支撑。我们推荐臀大肌劈开式肌皮瓣作为在行走和非行走患者中闭合小型低位骶尾溃疡的首选手术方法。
