股前外侧嵌合穿支皮瓣移植修复膝关节周围大面积复合组织缺损  

Anterolateral thigh chimeric perforator flap for repairing of large area compound tissue defect around knee joint

作　　者：吴攀峰[1] 唐举玉[1] 钟达[1] 卿黎明[1] 庞晓阳[1] 俞芳[1] 曾磊[1] 潘丁[1] 肖勇兵[1] 刘睿[1] 黄承雄 WU Panfeng;TANG Juyu;ZHONG Da;QING Liming;PANG Xiaoyang;YU Fang;ZENG Lei;PAN Ding;XIAO Yongbing;LIU Rui;HUANG Chenxiong(Department of Orthopaedics Surgery,Xiangya Hospital,Central South University,Changsha 410008,China)

机构地区：[1]中南大学湘雅医院骨科,长沙410008

出　　处：《中华显微外科杂志》2021年第5期507-511,共5页Chinese Journal of Microsurgery

基　　金：国家自然科学基金(81871577,81901978,82072194)。

摘　　要：目的探讨股前外侧嵌合穿支皮瓣移植修复膝关节周围大面积软组织缺损的可行性及临床疗效。方法自2015年1月至2019年10月,收治膝关节周围大面积软组织缺损患者9例,患者均有膝关节开放并不同程度的关节囊缺损。术前通过"皮肤提捏法"判断供区所能切取的皮瓣宽度并通过HHD探测并标记股前外侧区域各穿支位置。术中按照创面大小及形状设计布样,以供区能直接闭合为原则设计单叶或者分叶穿支皮瓣,裁剪布样,选择合适的穿支设计并切取皮瓣。皮瓣切取面积最小14.0 cm×5.0 cm,有1例双叶皮瓣面积最大,分别为17.0 cm×9.0 cm和18.0 cm×8.5 cm,并依据关节开放的位置和程度切取嵌合组织瓣(肌瓣或阔筋膜瓣)。嵌合组织瓣封闭关节腔,皮瓣修复膝关节创面,吻合供区与受区血管,重建皮瓣血运,关节腔置管冲洗引流,供区均直接闭合。通过门诊随访其恢复效果。结果术后9例患者皮瓣均顺利成活,未发生血管危象。1例患者皮瓣受区因冲洗引流不彻底渗出较多,经换药引流后延期愈合,其余皮瓣受区均Ⅰ期愈合。全部病例随访3~36(平均12)个月,受区外观、功能恢复满意,供区仅残留线形瘢痕。结论股前外侧嵌合穿支皮瓣是修复膝关节周围大面积软组织缺损较为理想的方法。Objective To investigate the feasibility and clinical efficacy of anterolateral thigh chimeric perforator flap in repair of large area soft tissue defects around the knee joint.Methods From January,2015 to October,2019,9 patients with large area soft tissue defects around the knee joint were treated.All patients had different degrees of defect in knee joint capsule and joint opening.Before operation,the width of the flap was determined by"skin lifting and kneading test",and the location of perforators in anterolateral femoral region was confirmed and marked with the assistance of HHD detector.According to the size and shape of the wound surface,single leaf or lobulated perforator flap was designed based on the principle that the donor site should be closed directly.The minimum size of the flap was 14.0 cm×5.0 cm,there was 1 case of lobulated flap with the largest area,respectively was 17.0 cm×9.0 cm and 18.0 cm×8.5 cm.The chimeric tissue flap(muscle flap or fascia lata flap)was taken according to the location and severity of joint opening.The grafted tissue flap was used to fill the articular cavity,the flap was used to repair the wound of knee joint,the blood supply of the flap was reconstructed,and a drainage catheter was placed in the cavity of knee joint.The recovery follow-up conducted in outpatient department.Results All flaps survived without vascular incident.The recipient site of flap in 1 patient was not thoroughly washed and drained,and there was more exudation.After dressing change and drainage,the rest recipient areas of the flap were healed in stage I.All patients entered 3 to 36(average 12)months of follow-up.The appearance and function of recipient area recovery were satisfactorily.Only a linear scar remained in donor site.Conclusion Anterolateral thigh chemeric perforator flap is ideal for repairing large soft tissue defects around the knee joint.

关 键 词：股前外侧穿支皮瓣 嵌合穿支皮瓣 膝关节 软组织缺损 修复 

分 类 号：R658.3[医药卫生—外科学]