腘窝直接皮动脉穿支蒂螺旋桨皮瓣转位修复腘窝软组织缺损  

Transferred direct popliteal cutaneous artery perforator propeller flap for repairing soft tissue defects of popliteal fossa

作　　者：张天浩[1] 王之江[2] 林涧[1] 刘蔡钺 吴立志 郑和平 Zhang Tianhao;Wang Zhijiang;Lin Jian;Liu Caiyue;Wu Lizhi;Zheng Heping(Research Center for Wound Prevention and Treatment,Xinhua Hospital(Chongming)Affiliated to Medical College,Shanghai Jiao Tong University,Shanghai 202150,China;Orthopedics Department,Xinhua Hospital(Chongming)Affiliated to Medical College,Shanghai Jiao Tong University,Shanghai 202150,China;Department of Plastic and Reconstrutive Surgery,Shanghai Ninth People’s Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200011,China;Department of Microsurgery,Taizhou Hospital,Wenzhou Medical University,Taizhou 317000,China;Comparative Medicine Department of the 900th Hospital of PLA Joint Logistic Support Force,Fuzhou 350025,China)

机构地区：[1]上海交通大学医学院附属新华医院(崇明)创面防治研究中心,202150 [2]上海交通大学医学院附属新华医院(崇明)骨科,202150 [3]上海交通大学医学院附属第九人民医院整复外科,200011 [4]温州医科大学附属浙江省台州医院手足显微外科,317000 [5]解放军联勤保障部队第900医院比较医学科,福州350025

出　　处：《中华整形外科杂志》2021年第1期72-78,共7页Chinese Journal of Plastic Surgery

基　　金：上海市科研计划项目(14411973200);上海市卫计委科研课题(201840198);上海市老龄化和妇儿健康研究专项计划项目(2020YJZX0143)。

摘　　要：目的探讨腘窝直接皮动脉穿支蒂螺旋桨皮瓣转位修复腘窝软组织缺损的临床效果。方法采用回顾性病例系列研究分析2013年6月至2019年6月,上海交通大学医学院附属新华医院(崇明)收治的9例腘窝软组织缺损患者临床资料,男6例,女3例,年龄25~73岁,平均49.6岁,腘窝缺损创面为6.5 cm×3.5 cm~17.0 cm×8.5 cm。根据解剖学基础,结合腘窝缺损创面的位置、大小、形状,设计并切取腘窝直接皮动脉穿支蒂螺旋桨皮瓣转位修复腘窝缺损创面,皮瓣面积最大为18.0 cm×10.0 cm,最小为7.5 cm×4.5 cm。根据皮瓣成活、感染控制、弹性色泽、外观形态、供区瘢痕、皮肤感觉、膝关节活动功能、患者认可度等情况,对患者术后疗效进行综合评价。结果 9例皮瓣术后全部顺利成活,供、受区伤口一期愈合,其中2例皮瓣远端发生皮缘坏死,给予换药处理后完全愈合。术后均获6~60个月随访,平均33个月,皮瓣成活优良,形态满意,色泽、弹性、质地与周围正常皮肤接近,供区瘢痕较小。疗效评价:满意8例,一般1例,无不满意。膝关节功能优7例,良1例,可1例。皮瓣肿胀评级,早期:Ⅰ度6例,Ⅱ度2例,Ⅲ度1例,Ⅳ度0例;后期:Ⅰ度8例,Ⅱ度1例,Ⅲ度0例,Ⅳ度0例。结论腘窝直接皮动脉穿支蒂螺旋桨皮瓣移位修复腘窝缺损创面方法简便、安全可靠、损伤较小,易于推广,是修复腘窝皮肤软组织缺损的理想方法之一。Objective To evaluate the clinical effect of transferred direct popliteal cutaneous artery perforator propeller flap for repairing soft tissue defects of the popliteal fossa.Methods The clinical data of 9 patients with defects of popliteal fossa from June 2013 to June 2019 were analyzed retrospectively,in which including 6 men and 3 women whose ages ranged from 25 to 73 years old.The sizes of soft tissue defects ranged from 6.5 cm×3.5 cm to 17.0 cm×8.5 cm.Perforator propeller flap was designed and cut to repair the defects according to the location,size and shape of defects,in which the largest was 18.0 cm×10.0 cm and the smallest was 7.5 cm×4.5 cm.To evaluate the effect according to survival,infection control,elasticity and color,appearance of the flaps,the scar at the donor site,cutaneous sense,knee joint function,and patients’satisfaction.Results All the flaps survived.The incisions in donor and recipient site were primary healing.The survival of flaps was good.The appearance,color,and elasticity were close to normal.On the other hand,the scar at the donor site was small after 6 to 60 months follow-up.2 cases appeared necrosis on edge of distal flaps and were healed after dressing.The efficacy was satisfactory in 8 cases,general in 1 case and without dissatisfactory.The function of knee joint was excellent in 7 cases,good in 1 case,and general in 1 case.Skin swelling rating in early-stage was 1st degree in 6 patients,2nd degree in 2 patients,3rd degree in 1 patient;in the later stage was 1st degree in 8 patients,2nd degree in 1 patient.Conclusions It is simple,safe and reliable to repair soft tissue defects of popliteal fossa with transferred direct popliteal cutaneous artery perforator propeller flap,which would be an ideal method for repairing soft tissue defects of the popliteal fossa.

关 键 词：穿支皮瓣 腘动脉 创伤和损伤 腘窝 腘窝直接皮动脉 螺旋桨皮瓣 

分 类 号：R658.3[医药卫生—外科学]