逆行股前外侧皮瓣、肌皮瓣转移治疗膝周及小腿上段软组织缺损伴感染

Treatment for soft tissue defect combined with infection in the knee and upper leg used reverse anterolateral thigh flap or musculocutaneous flap

目的探讨以膝上外侧动脉为蒂的逆行股前外侧皮瓣、肌皮瓣转移治疗膝周及小腿上段软组织缺损伴感染的临床疗效。方法2007年3月至2008年3月，11例各种原因导致膝关节周围及小腿上段软组织缺损伴感染的患者，男8例，女3例；年龄23--65岁，平均33．4岁；左腿7例，右腿4冽。病史最长8个月，最短6h。1例为开放性创伤致膝前下方皮肤及软组织缺损伴胫骨平台骨折，予一期清创、骨折内固定及皮瓣转移治疗；10例膝周及小腿上段慢性皮肤、软组织缺损伴感染，经抗感染、清创、引流等治疗后再行逆行股前外侧皮瓣转移二期修复软组织缺损。创面面积最大12cm×7cm，最小6.3cm×3．0cm。结果11例患者均获得随访，随访时间3-6个月，平均4．7个月。所有转移皮瓣、肌皮瓣在术后全部成活。其中3例于术后1-2周因转移的皮瓣皮缘愈合差，再次行皮瓣边缘修整术。9例供区采取直接缝合，2例供区予部分缝合加植皮。术后3个月所有皮瓣均未发生坏死或感染，无膝关节活动障碍。结论对膝周及小腿上段软组织缺损伴感染的病例，控制感染后，可采用逆行股前外侧皮瓣、肌皮瓣进行修复。股前外侧皮瓣薄，易存活，肌皮瓣可填塞空腔，抗感染力强，且供区常可直接缝合，减少手术创伤。

Objective To investigate the clinical effect of reverse anterolateral thigh flap with lateral superior genicular artery or musculocutaneous flap for treating soft tissue defect combined with infection in the knee and upper leg. Methods From March 2007 to March 2008, 11 patients with soft tissue defect combined with infection in the knee and upper leg were treated in our hospital. There were 8 males, 3 females, with the mean age of 33.4 years （range, 23-65 years）, left thigh for 7 patients and right thigh for 4 patients. The course of disease was ranged for 6 hours to 8 months. One patient was caused by a open injury leading to skin and soft tissue defect in the anteroinferior knee combined with the fracture of tibial plateau, and was treated with debridement, internal fixation and transfen＇ing flap; ten patients were caused by the chronics infection with skin and soft tissue defect, and were treated with transferring anterolateral thigh flap later after treating with anti-infection, debridement and drainage. The injury area ranged from 6.3 cm×3.0 cm to 12 cm×7 cm. Results All patients were followed up for 3 to 6 months, with the average 4.7 months. All the flaps kept alive after operation. Three cases were debrided again in the followed 1-2 weeks because of the unhealing borderline of the flaps. Nine cases were sutured without need for skin graft, 2 cases had partial skin graft. No infection and necrosis were found in all flaps and the flaps were all alive after 3 months follow-up. The knee joints of all patients had a good motion. Conclusion The soft tissue defect combined with infection in the knee and upper leg can be treated with reverse anterolateral thigh flap, after controlling in- fection successfully. The flaps were thin and easy to alive, the musculocutaneous flaps can obturate the space and anti-infection. This method can reduce the operative trauma especially without need for the skin graft and get a good effect.