膝上外侧动脉穿支皮瓣修复四肢皮肤软组织缺损
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摘要
目的探讨膝上外侧动脉穿支皮瓣修复四肢皮肤软组织缺损的可行性及临床效果。方法 2010年9月—2017年10月,收治11例四肢皮肤软组织缺损患者。男10例,女1例;年龄6～72岁,平均37.6岁。致伤原因:交通事故伤6例,机器绞压伤1例,摔伤1例,高处坠落伤1例,重物砸伤1例,电击伤1例。皮肤软组织缺损部位:前臂1例,膝部5例,腘窝2例,小腿1例,足踝部2例。创面范围8.0 cm×4.5 cm～27.0 cm×8.0 cm。受伤至入院时间为3～12 d,平均6 d。切取大小为9.0 cm×5.5 cm～28.0 cm×9.0 cm的膝上外侧动脉穿支皮瓣修复创面;游离移植3例,带蒂移位8例。供区均直接缝合。结果术后8例皮瓣顺利成活,创面Ⅰ期愈合;2例皮瓣发生动脉危象、1例发生静脉危象,均经对症处理后创面修复。受区均未出现血肿和继发感染。供区切口均Ⅰ期愈合。术后10例患者获随访,随访时间2～48个月,平均13.1个月。皮瓣外形、颜色、质地良好,膝关节活动未受限。结论膝上外侧动脉穿支皮瓣修复四肢创面可行,既可带蒂移位修复膝关节周围皮肤软组织缺损,又可游离移植修复前臂、足部等四肢皮肤软组织缺损,并能获得较好疗效。
Objective To investigate the feasibility and effectiveness of the superior lateral genicular artery perforator flap for repairing of soft tissue defects in extremities. Methods Between September 2010 and October 2017, 11 cases of skin and soft tissue in extremities were repaired with the superior lateral genicular artery perforator flap. There were 10 males and 1 female, with an average age of 37.6 years(range, 6-72 years). The causes of injury were traffic accident in 6 cases, machine injury in 1 case, falling down injury in 1 case, falling from height in 1 case, crushing injury in 1 case,and electric injury in 1 case. The defects located at the forearm in 1 case, knee in 5 cases, popliteal fossa in 2 cases, shank in1 case, and foot and ankle in 2 cases. The area of the wound ranged from 8.0 cm×4.5 cm to 27.0 cm×8.0 cm. The interval from injury to admission was 6 days on average(range, 3-12 days). The area of perforator flap ranged from 9.0 cm×5.5 cm to 28.0 cm×9.0 cm. There were 8 cases of pedicle flap and 3 cases of free flap. All the donor sites were closed directly. Results Eight flaps survived without any complications and the donor sites healed by first intention. Two flaps had arterial crisis and 1 flap had venous crisis after operation, and the wounds healed after symptomatic treatment. There was no hematoma and secondary infections in all patients after operation. Ten patients were followed up 2-48 months(mean, 13.1 months). All flaps had satisfied appearance and texture. There was no motion limitations in the hip and knee joints of the operated legs. Conclusion The superior lateral genicular artery perforator flap not only can be used to repair the soft tissue defect around the knee joint as pedicle flap, but also can be used to repair the forearm and foot skin and soft tissue defects as free flap, which is a feasible way to repair soft tissue defects in extremities.
Objective To investigate the feasibility and effectiveness of the superior lateral genicular artery perforator flap for repairing of soft tissue defects in extremities. Methods Between September 2010 and October 2017, 11 cases of skin and soft tissue in extremities were repaired with the superior lateral genicular artery perforator flap. There were 10 males and 1 female, with an average age of 37.6 years(range, 6-72 years). The causes of injury were traffic accident in 6 cases, machine injury in 1 case, falling down injury in 1 case, falling from height in 1 case, crushing injury in 1 case,and electric injury in 1 case. The defects located at the forearm in 1 case, knee in 5 cases, popliteal fossa in 2 cases, shank in1 case, and foot and ankle in 2 cases. The area of the wound ranged from 8.0 cm×4.5 cm to 27.0 cm×8.0 cm. The interval from injury to admission was 6 days on average(range, 3-12 days). The area of perforator flap ranged from 9.0 cm×5.5 cm to 28.0 cm×9.0 cm. There were 8 cases of pedicle flap and 3 cases of free flap. All the donor sites were closed directly. Results Eight flaps survived without any complications and the donor sites healed by first intention. Two flaps had arterial crisis and 1 flap had venous crisis after operation, and the wounds healed after symptomatic treatment. There was no hematoma and secondary infections in all patients after operation. Ten patients were followed up 2-48 months(mean, 13.1 months). All flaps had satisfied appearance and texture. There was no motion limitations in the hip and knee joints of the operated legs. Conclusion The superior lateral genicular artery perforator flap not only can be used to repair the soft tissue defect around the knee joint as pedicle flap, but also can be used to repair the forearm and foot skin and soft tissue defects as free flap, which is a feasible way to repair soft tissue defects in extremities.
引文
1潘宝华,鲁开化,郭树忠,等.膝上内侧筋膜皮瓣修复膝关节周围软组织缺损.中国修复重建外科杂志,2002,16(4):291.
2孙广峰,聂开瑜,邓呈亮,等.游离旋骼浅动脉穿支皮瓣修复足踝部皮肤软组织缺损.中国修复重建外科杂志,2016, 30(11):1396-1399.
3陈长顺,胡祥,郑前进,等.胫后动脉穿支远端蒂复合组织瓣修复小腿远端创面.中国修复重建外科杂志,2019, 33(1):75-79.
4李倩,肖海涛,岑瑛.选择性修薄股前外侧皮瓣修复足跟及足跟后区缺损.中国修复重建外科杂志,2018, 32(3):350-353.
5 Hayashi A, Maruyama Y. The lateral genicular artery flap. Ann Plast Surg, 1990, 24(4):310-317.
6 Wiedner M, Koch H, Scharnagl E. The superior lateral genicular artery flap for soft-tissue reconstruction around the knee:clinical experience and review of the literature. Ann Plast Surg, 2011, 66(4):388-392.
7 Taniguchi Y, Kitano T, Shimoe T, et al. Superior lateral genicular artery flap for coverage of a soft tissue defect after total knee arthroplasty. J Reconstr Microsurg, 2009,25(8):479-482.
8 Spokevicius S, Jankauskas A. Anatomy and clinical applications ofa composite cutaneo-subcutaneous flap based on the lateral superior genicular vessels. J Reconstr Microsurg, 1995, 11(1):15-20.
9夏晓丹.股外侧穿支皮瓣的应用解剖与临床研究.衡阳:南华大学,2010.
10王树锋,周忠水,于胜军,等.膝上外侧动脉为蒂股骨远端骨皮瓣的应用解剖.中华显微外科杂志,2001,24(1):46-48.
11许亚军,陈政,包岳丰,等.股前外-膝上外侧逆行岛状皮瓣修复小腿软组织缺损.中华显微外科杂志,2013, 36(1):63-65.
12 Morsy M, Sur YJ, Saint-Cyr M, et al. Detailed anatomy of the superior lateral genicular artery for design of a vascularized bone flap from the lateral femoral condyle. Plast Reconstr Surg, 2015,136(4 Suppl):14-15.
13于晓光,石硕,李军,等.膝外上旋股外侧动脉降支穿支皮瓣修复膝周围软组织缺损.中华显微外科杂志,2014, 37(3):291-293.
14王玉发,何英敏,王大伟,等.旋股外侧动脉降支与膝外上动脉双轴点皮瓣的临床应用.中华显微外科杂志,2008, 31(6):444-446.
15高建明,徐达传,储旭东,等.膝上外侧动脉穿支髂胫束皮瓣的解剖特点与临床应用.中华显微外科杂志,2010, 33(6):450-453.
16邢进峰,陈中,曹扬,等.膝上外侧血管复合组织瓣移植的应用解剖.中国临床解剖学杂志,2001,19(4):329-331.
17邢进峰,张春,陈中,等.膝上外侧动脉复合皮瓣的临床应用.中华显微外科杂志,2001,24(3):211-212.
2孙广峰,聂开瑜,邓呈亮,等.游离旋骼浅动脉穿支皮瓣修复足踝部皮肤软组织缺损.中国修复重建外科杂志,2016, 30(11):1396-1399.
3陈长顺,胡祥,郑前进,等.胫后动脉穿支远端蒂复合组织瓣修复小腿远端创面.中国修复重建外科杂志,2019, 33(1):75-79.
4李倩,肖海涛,岑瑛.选择性修薄股前外侧皮瓣修复足跟及足跟后区缺损.中国修复重建外科杂志,2018, 32(3):350-353.
5 Hayashi A, Maruyama Y. The lateral genicular artery flap. Ann Plast Surg, 1990, 24(4):310-317.
6 Wiedner M, Koch H, Scharnagl E. The superior lateral genicular artery flap for soft-tissue reconstruction around the knee:clinical experience and review of the literature. Ann Plast Surg, 2011, 66(4):388-392.
7 Taniguchi Y, Kitano T, Shimoe T, et al. Superior lateral genicular artery flap for coverage of a soft tissue defect after total knee arthroplasty. J Reconstr Microsurg, 2009,25(8):479-482.
8 Spokevicius S, Jankauskas A. Anatomy and clinical applications ofa composite cutaneo-subcutaneous flap based on the lateral superior genicular vessels. J Reconstr Microsurg, 1995, 11(1):15-20.
9夏晓丹.股外侧穿支皮瓣的应用解剖与临床研究.衡阳:南华大学,2010.
10王树锋,周忠水,于胜军,等.膝上外侧动脉为蒂股骨远端骨皮瓣的应用解剖.中华显微外科杂志,2001,24(1):46-48.
11许亚军,陈政,包岳丰,等.股前外-膝上外侧逆行岛状皮瓣修复小腿软组织缺损.中华显微外科杂志,2013, 36(1):63-65.
12 Morsy M, Sur YJ, Saint-Cyr M, et al. Detailed anatomy of the superior lateral genicular artery for design of a vascularized bone flap from the lateral femoral condyle. Plast Reconstr Surg, 2015,136(4 Suppl):14-15.
13于晓光,石硕,李军,等.膝外上旋股外侧动脉降支穿支皮瓣修复膝周围软组织缺损.中华显微外科杂志,2014, 37(3):291-293.
14王玉发,何英敏,王大伟,等.旋股外侧动脉降支与膝外上动脉双轴点皮瓣的临床应用.中华显微外科杂志,2008, 31(6):444-446.
15高建明,徐达传,储旭东,等.膝上外侧动脉穿支髂胫束皮瓣的解剖特点与临床应用.中华显微外科杂志,2010, 33(6):450-453.
16邢进峰,陈中,曹扬,等.膝上外侧血管复合组织瓣移植的应用解剖.中国临床解剖学杂志,2001,19(4):329-331.
17邢进峰,张春,陈中,等.膝上外侧动脉复合皮瓣的临床应用.中华显微外科杂志,2001,24(3):211-212.