中国修复重建外科杂志

中国修复重建外科杂志

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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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,既可以游离移植修复前臂、足部皮肤软组织缺损,又可带蒂移位修复膝关节周围皮肤软组织缺损,并能获得较好疗效。

ObjectiveTo investigate the feasibility and effectiveness of the superior lateral genicular artery perforator flap for repairing of soft tissue defects in extremities.MethodsBetween 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 in 1 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 between 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.ResultsEight 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.ConclusionThe superior lateral genicular artery perforator flap not only can be used to repair the forearm and foot skin and soft tissue defects as free flap, but also can be used to repair the soft tissue defect around the knee joint as pedicle flap, which is a feasible way to repair soft tissue defects in extremities.

关键词: 膝上外侧动脉穿支皮瓣; 穿支皮瓣; 四肢; 创面修复

Key words: Superior lateral genicular artery perforator flap; artery perforator flap; extremity; wound repair

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