观察双侧阴部内动脉穿支皮瓣在肛周皮肤软组织缺损修复中的应用效果。

2022年7月至2024年12月，北京大学首钢医院修复重建外科收治的采用双侧阴部内动脉穿支皮瓣修复肛周皮肤软组织缺损患者26例，其中男17例、女9例，年龄40~62岁，中位数49.5岁。结直肠恶性肿瘤患者20例，肛周恶性肿瘤患者6例。肛周皮肤软组织缺损面积为22 cm×7 cm~32 cm×14 cm。术后观察皮瓣成活情况、供区和受区愈合情况及有无并发症。随访观察臀部活动以及瘢痕情况。

26例患者共采用52个阴部内动脉穿支皮瓣，术后全部成活，皮瓣面积为14 cm×5 cm~19 cm×7 cm。随访2~16个月，中位数6.4个月。1例患者皮瓣下方出现积液，尖端部分坏死，经换药后好转。5个皮瓣出现延迟愈合，4个皮瓣因患者下地活动导致切口裂开，均通过换药后好转。25例患者臀沟自然，1例患者骶尾连接处瘢痕较重，对臀部活动有轻度影响。26例患者对手术效果均满意。

采用双侧阴部内动脉穿支皮瓣修复肛周皮肤软组织缺损，皮瓣血运可靠，可以在封闭创面的同时重建臀沟，对称性良好，外形佳，对邻近泌尿生殖器牵拉小，值得临床推广应用。

To observe the application effect of bilateral internal pudendal artery perforator flaps in the repair of perianal skin and soft tissue defects.

From July 2022 to December 2024， 26 patients with perianal skin and soft tissue defects were treated with bilateral internal pudendal artery perforator flaps at the Department of Repair and Reconstruction Surgery， Shougang Hospital， Peking University， including 17 males and 9 females， aged 40–62（49.5） years. There were 20 cases of colorectal malignant tumors and 6 cases of perianal malignant tumors. The area of perianal skin and soft tissue defects ranged from 22 cm×7 cm to 32 cm×14 cm. Postoperatively， the survival of the flaps， the healing of the donor and recipient sites， and the presence of complications were observed. Follow-up observations were made on the movement of the buttocks and the scar conditions.

A total of 52 internal pudendal artery perforator flaps were used in the 26 patients， all of which survived postoperatively. The flap area ranged from 14 cm×5 cm to 19 cm×7 cm. The follow-up period was 2–16（6.4） months. One patient developed fluid accumulation under the flap with partial necrosis at the tip， which improved after dressing changes. Five flaps exhibited delayed healing， and four flaps developed incision dehiscence due to early ambulation， all of which improved after dressing changes. Twenty-five patients had natural gluteal folds， while one patient had significant scarring at the sacrococcygeal junction， which mildly affected hip movement. All 26 patients were satisfied with the surgical outcomes.

The use of bilateral internal pudendal artery perforator flaps for repairing perianal skin and soft tissue defects provides reliable blood supply. It effectively closes wounds while reconstructing the gluteal fold， achieving good symmetry and aesthetic appearance with minimal traction on adjacent urogenital structures. This method is worthy of clinical promotion and application.