Clinical Application Of Superior Gluteal Artery Perforator Flap Combined With Vaccum Sealing Drainage In Repair Of The Hip

Objective:The anatomy and clinical application of superior gluteal artery perforator(S-GAP)flap were analyzed and summarized by a case-control study with clinical practice.In addition,the clinical efficacy of S-GAP flap combined with vacuum assisted closure(VAC)in the repair of bedsores of the hip(including the sacrococcygeal region and sciatic tuberosities).Methods:Twelve patients with intractable bedsores of the hip(7 males and 5 females;age range,44-78 years;area range of bedsores,3 cm × 3 cm-20 cm × 10 cm;area range of skin flaps,5 cm × 4 cm-22 cm × 11 cm;course of disease,3 months-15 years)were selected between September 2015 and September 2017.Among them,6 patients had complicated paraplegia,5 patients suffered from long-term bed rest and 1 patients showed recrudesce after traditional surgery.Based on combined treatment,one-stage effective debridement combined with VAC was performed till fresh granulation tissue on wounds.One-2 weeks later,second-stage transplantation of S-GAP flap was conducted,covered with VAC materials.After continuous drainage,skin flap healing,wound healing and functional recovery were observed and recorded.Results:In these 12 patients with bedsores of the sacrococcygeal region and sciatic tuberosities,fresh granulation tissues presented ruddy granules and good growth after debridement combined with VAC for 1-2 times.During the second-stage transplantation of S-GAP flap combined with VAC,perforation was found to be consistent with the results of preoperative ultrasonic Doppler blood flow detection.All skin flaps survived,with an area of 5 cm × 4 cm-22 cm × 11 cm.Stage I wound healing was detected in 11 patients and the rest 1 patient was self-cured 1-2 weeks after dressing changes.Follow-up was performed for 6 to 12 months,revealing satisfactory results.Appearance recovered well and scars on the edge of skin flaps faded gradually.Moreover,the quality of life was improved in varying degrees and patients were satisfied with the overall shape of the hip and postoperative exercise recovery,with good hip and knee flexion and extension.No severe complications or recurrent bedsores occurred.Conclusion:S-GAP flaps are characterized by reliable and rich blood supply,easy survival,superficial anatomy,easy operation,easy shaping,flexibility,good and full shape,small damage to donor area,not obvious postoperative atrophy of skin flaps,stable and reliable displacement with high resistance to pressure,good buffering and protection to catapophysis of the hip,preservation of the integrity of the gluteus maximus for later functional recovery,reservation of the opportunity for the second surgical repair,and ideal effect in intractable bedsores.Combined VAC can contribute to adequate drainage,and thereby effectively preventing and treating infection,stabilizing wound environment,closing to tissue,converging wound and lacuna,improving blood circulation,and stimulating the growth of neatly and fresh granulation tissues,so as to promote wound healing to avoid incomplete healing or even recurrence.S-GAP flap combined with VAC is an effective and reliable repair method for bedsores of the hip.It is worthy of clinical promotion.