PDF(Pubmed)
Abstract：
Background/Objectives: Perineal reconstruction after abdominoperineal excision often requires complex closures and is fraught with wound healing complications. Flap-based approaches introduce non-irradiated vascularized tissue to the area of resection to fill a large soft-tissue defect and dead space, reduce the risk of infection, and facilitate wound healing. Employing perforator flaps with their beneficial donor site properties, the authors have developed a concept of bilateral superior gluteal artery perforator (SGAP) flaps to restore extensive perineal defects. Methods: This retrospective case series was conducted between September 2015 and December 2019. We included three patients who received bilateral SGAP flap reconstruction after oncological resection. One deepithelialized SGAP flap was used for obliteration of dead space, combined with the contralateral SGAP flap for superficial defect reconstruction and wound closure. Results: Within this patient population, two male and one female patient, with a median age of 62 years (range, 52-76 years), were included. Six pedicled SGAP flaps were performed with average flap dimensions of 9 × 20 cm (range 7-9 × 19 × 21). No flap loss or no local recurrence were documented. In one case, partial tip necrosis with prolonged serous drainage was observed, which was managed by surgical debridement. No further complications were detected. Conclusions: The combination of two SGAP flaps provides maximal soft tissue for defect reconstruction and obliteration of dead space, while maintaining a very inconspicuous donor site, even with bilateral harvesting. Given these advantages, the authors recommend this promising approach for successful reconstruction of perineal defects.
摘要：
背景/目的：腹部手术切除后的会阴重建通常需要复杂的闭合，并且充满了伤口愈合并发症。基于皮瓣的方法将未辐照的血管化组织引入切除区域，以填充大的软组织缺损和死腔，降低感染的风险，并促进伤口愈合。使用具有有益供体部位特性的穿支皮瓣，作者提出了双侧臀上动脉穿支(SGAP)皮瓣修复会阴广泛缺损的概念.方法：该回顾性病例系列于2015年9月至2019年12月进行。我们纳入了3例肿瘤切除后接受双侧SGAP皮瓣重建的患者。一个深层SGAP皮瓣用于消除死腔，结合对侧SGAP皮瓣进行浅层缺损重建和伤口闭合。结果：在该患者人群中，两名男性和一名女性患者，平均年龄为62岁(范围，52-76岁），包括在内。进行了六个带蒂SGAP皮瓣，平均皮瓣尺寸为9×20cm（范围7-9×19×21）。无皮瓣丢失或局部复发记录。在一个案例中,观察到部分尖端坏死伴浆液性引流时间延长，这是通过手术清创术管理。没有发现进一步的并发症。结论：两种SGAP皮瓣的组合为缺损的重建和死腔的消除提供了最大的软组织。同时保持一个非常不起眼的捐赠地点，即使是双边收获。鉴于这些优势，作者推荐这种有希望的方法成功重建会阴缺损.
