游离膝降动脉穿支皮瓣的临床研究

Clinical study of free descending genicular artery perforator flap

目的研究膝降动脉穿支皮瓣的应用解剖及修复手部软组织缺损的临床效果。方法对10侧成人下肢尸体标本经股动脉注入红色乳胶液，解剖观测膝降动脉穿支血管在股内侧区的分布、起源等。临床应用游离膝降动脉穿支皮瓣修复手部软组织缺损9例。皮瓣切取面积为5cm×8cm-6cm×15cm。结果膝降动脉由股动脉在股骨内侧髁上平均（12．4±1．3）cm处发出1～3支相对恒定的皮穿支血管，营养股内侧皮瓣。临床应用9例，皮瓣完全存活，术后随访时间为6．18个月，皮瓣质地优良，外形与功能恢复满意，供区留有线条瘢痕，下肢行走功能无影响。结论以膝降动脉穿支血管营养的股前内侧皮瓣血供可靠，质地优良，是修复手部组织缺损的良好选择。

Objective To investigate the applied anatomy of descending genicular artery perforator flap and report the clinical results of treating hand soft tissue defects with free transfer of the flap. Methods The origin, course, distribution and outer diameter of descending genicular artery perforators, which were located at the medial thigh, were observed on 10 adult cadaveric lower extremities perfused with red latex through the femoral artery. Clinically nine cases of soft-tissue defect in the hand were treated with transfer of the descending genicular artery perforator flap. The area of the flaps ranged from 5 cm × 8 cm to 6 cm × 15 cm. Results The descending genicular artery originated from the femoral artery （12.4 ：i： 1.3） cm above the medial condyle. It sent 1 to 3 relatively constant perforators proximally to feed skin of the medial thigh. All of 9 cases of free descending genicular artery perforator flap survived uneventfully. Follow-up of 6 to 18 months showed good texture and appearance of the flaps. Functional results were satisfactory. Only a linear scar was left at the donor site. Walking and gait was normal. Conclusion Descending genicular artery perforator flap from the medial thigh has reliable blood supply and good texture. It is a good option for repairing soft-tissue defect in the hand.