探讨分次分步清创与封闭式负压引流及脱细胞真皮基质等适宜技术相结合的手术方式对经导管动脉栓塞术（TAE）后臀肌及皮肤坏死的治疗效果。

2020年8月至2023年9月，江苏省苏北人民医院整形烧伤科收治符合入选标准的骨盆骨折大出血行TAE术后臀肌及皮肤坏死患者6例，其中男4例，女2例，年龄42~65岁。患者均采用分次分步清创与封闭式负压引流及脱细胞真皮基质等适宜技术相结合的手术方式进行治疗。观察患者TAE术后肌酸激酶水平变化、臀肌及皮肤坏死的CT或MRI影像学特征，统计创面治疗手术次数、创面愈合时间及创面愈合情况。

患者肌酸激酶水平在TAE术后1~3 d总体呈上升趋势，于术后3~7 d达到高峰，高水平状态（>10 000 U/L）持续2~7 d。CT或MRI均表现为臀部软组织及臀肌（臀大肌、臀中肌及臀小肌）水肿，部分肌肉密度不均匀。创面治疗手术次数为（4.7±0.8）次，创面愈合时间为（42.5±5.4）d。6例患者术后创面均愈合良好，随访2个月未出现创面破溃或渗液。

分次分步清创与封闭式负压引流及脱细胞真皮基质等适宜技术相结合，能够有效治疗TAE术后臀肌及皮肤坏死。

To explore the therapeutic effect of the surgical approach combining staged debridement， vacuum sealing drainage and acellular dermal matrix and other appropriate techniques on gluteal muscle and skin necrosis after transcatheter arterial embolization （TAE）.

From August 2020 to September 2023， 6 patients with gluteal muscle and skin necrosis after TAE for massive hemorrhage caused by pelvic fracture who met the inclusion criteria were admitted to the Department of Plastic and Burn Surgery， Northern Jiangsu People's Hospital， including 4 males and 2 females， aged 42 to 65 years. All patients were treated with a surgical method combining staged debridement， vacuum sealing drainage and acellular dermal matrix and other appropriate techniques. The changes of creatine kinase levels after TAE and the CT or MRI imaging characteristics of gluteal muscle and skin necrosis were observed. The number of wound treatment operations， wound healing time and wound healing status were recorded.

The creatine kinase levels showed an overall upward trend from 1 to 3 days after TAE， peaked at 3 to 7 days after surgery， and maintained a high level （>10 000 U/L） for 2 to 7 days. CT or MRI showed edema of gluteal soft tissues and gluteal muscles （gluteus maximus， gluteus medius and gluteus minimus）， with uneven density of some muscles. The number of wound treatment operations was （4.7±0.8） times， and the wound healing time was （42.5±5.4） days. All 6 patients achieved good wound healing after surgery， and no wound rupture or exudation was found during the 2-month follow-up.

The combination of staged debridement， vacuum sealing drainage， acellular dermal matrix and other appropriate techniques can effectively treat gluteal muscle and skin necrosis after TAE.