全膝关节置换后创面的皮瓣转移修复  

Wounds repaired by flap transfer after total knee arthroplasty

作　　者：陈建国 钱文伟[1] 彭慧明[1] Chen Jianguo;Qian Wenwei;Peng Huiming(Peking Union Medical College Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100730,China;Plastic Surgery Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Beijing 100144,China)

机构地区：[1]中国医学科学院北京协和医学院,北京协和医院,北京市100730 [2]中国医学科学院北京协和医学院,整形外科医院,北京市100144

出　　处：《中国组织工程研究》2020年第12期1929-1934,共6页Chinese Journal of Tissue Engineering Research

基　　金：北京市自然科学基金面上项目(7192173)，项目负责人：钱文伟~~

摘　　要：背景:全膝关节置换后伤口并发症可能导致严重后果,给骨科医生带来极大挑战。如果膝关节周围创面较大,并且深及筋膜层或有假体、骨、关节、肌腱、大血管、神经等暴露,则无法通过伤口频繁换药、持续引流、浅表或深部伤口清创、负压吸引、植皮等手段实现二期愈合,此时骨科医生应请整形外科医生会诊,并考虑行皮瓣转移修复。目的:介绍了可用于修复全膝关节置换后创面的皮瓣类型,有助于骨科医生对皮瓣的理解和合理选用,减少因软组织缺损创面带来的严重后果。方法:第一作者通过计算机检索PubMed、Medline、万方、CNKI数据库建库至2019年关于皮瓣转移修复全膝关节置换后创面的文献,中文检索词为“皮瓣,膝关节,创面”,英文检索词为“flap,knee,wound”,共检索到668篇文献,按纳入和排除标准对文献进行筛选,最终纳入45篇文献进行分析。结果与结论:①皮瓣转移修复在整形外科上广泛应用,骨科医生认识各皮瓣的特征至关重要;②依据创面的三维结构、位置的特点选择、设计合适的皮瓣有助于修复全膝关节置换后软组织缺损,进而减少全膝关节置换后假体暴露、假体周围感染、假体取出甚至截肢的风险。BACKGROUND:Wound complications probably result in severe soft tissue defects after total knee arthroplasty,which brings orthopedic surgeon a big challenge.Some treatment options,such as frequent sterile dressings changes,persistent drainage,minor or thorough debridement,negative pressure wound therapy and split-thickness skin grafts,fail to help those quite large and deep wounds around the knee,with exposed fascia or prosthesis,bone,joint,tendon,large vessels and nerve,heal by secondary intention.Under these situations,orthopedic surgeon should consult plastic surgery and propose flap re-construction.OBJECTIVE:To introduce some types of flaps for orthopedic surgeon,so as to help orthopedic surgeon understand and chose flaps logically,and reduce severe consequences caused by soft tissue defect wounds.METHODS:The first author retrieved databases of PubMed,Medline,Wanfang and CNKI for the articles concerning wounds repaired by flap transfer after total knee arthroplasty published before 2019.The key words were“flap,knee,wound”in Chinese and English,respectively.Initially 668 articles were retrieved and 45 eligible articles were included in accordance with the inclusion and exclusion criteria for analysis.RESULTS AND CONCLUSION:(1)Flap reconstruction is widely applied in plastic surgery.It is significant for orthopedic surgeon to recognize the characteristics of each flap.(2)Selecting and designing suitable type of flap according to the three-dimensional structure and position of wounds is helpful for repairing soft tissue defect,reducing the risks of prosthesis exposure,periprosthetic infection,prosthesis removal and even amputation after total knee replacement after total knee arthroplasty.

关 键 词：皮瓣 局部皮瓣 肌瓣 肌皮瓣 游离皮瓣 皮瓣修复 全膝关节置换 创面 伤口并发症 

分 类 号：R459.9[医药卫生—治疗学] R318[医药卫生—临床医学]