대내전근 천공지 도상 피판을 이용한 좌골부 연부조직결손의 재건

Reconstruction of Ischial Soft Tissue Defects using Adductor Magnus Perforator Island Flap

  • 김의식 (전남대학교 의과대학 성형외과학교실) ;
  • 박장완 (전남대학교 의과대학 성형외과학교실) ;
  • 황재하 (전남대학교 의과대학 성형외과학교실) ;
  • 김광석 (전남대학교 의과대학 성형외과학교실) ;
  • 이삼용 (전남대학교 의과대학 성형외과학교실)
  • Kim, Eui Sik (Department of Plastic and Reconstructive Surgery, Chonnam National University Medical School) ;
  • Park, Jang Wan (Department of Plastic and Reconstructive Surgery, Chonnam National University Medical School) ;
  • Hwang, Jae Ha (Department of Plastic and Reconstructive Surgery, Chonnam National University Medical School) ;
  • Kim, Kwang Seog (Department of Plastic and Reconstructive Surgery, Chonnam National University Medical School) ;
  • Lee, Sam Yong (Department of Plastic and Reconstructive Surgery, Chonnam National University Medical School)
  • 발행 : 2009.09.15

초록

Purpose: Surgical reconstruction of an ischial soft tissue defect presents a challenging problem owing to a high rate of recurrence, especially paraplegic patients. Although various muscle, musculocutaneous and fasciocuta - neous flaps have been used in the reconstruction of ischial soft tissue defect, it is still debated which type of flaps are the best. We had performed a relatively durable adductor magnus perforator island flap based on the perforators originated from the first medial branch of the profunda femoris artery for coverage of ischial soft tissue defect where was not a region universally reconstructed by perforator flap. Methods: From August 2005 until January 2008, the adductor magnus perforator island flap had been used for resurfacing of the ischial soft tissue defects in a series of 6 patients (4 male and 2 female). Ages ranged from 26 to 67 years (mean, 47.5 years), and follow - up period from 13 to 26 months (mean, 16.7 months). Causes were 4 pressure ulcers, 1 cellulitis and 1 suppurative keratinous cyst. Results: The sizes of these flaps ranged from 12 to 18 cm in length and 7 to 9 cm in width. The flaps survived in all patients. Marginal loss over the distal area of the flap by infection was noted in one patient, which was treated successfully with a subsequent split - thickness skin graft. Average thickness of the flap was 0.94 cm, which was more thicker than other perforator flaps. Long term follow - up showed a good flap durability. Conclusion: In planning a reconstructive option of ischial soft tissue defect, the adductor magnus perforator island flap is a relatively large cutaneous flap with a durable thickness. With proper patient selection, careful vascular dissection and postoperative management, we recommend this flap is a good and suitable option for coverage of the ischial soft tissue defect.

키워드

참고문헌

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