游离膝降动脉股内侧穿支皮瓣修复四肢软组织缺损

Anatomy of the free descending genicular artery perforator flap and its clinical application for soft- tissue defects at extremities

目的探讨游离膝降动脉股内侧穿支皮瓣修复四肢远端软组织缺损的可行性。方法对10具尸体行一次性全身动脉造影、螺旋CT扫描及三维重建，观测膝降动脉行程及穿支分布特点。临床应用游离膝降动脉股内侧穿支皮瓣修复四肢软组织缺损11例，皮瓣切取面积5cm×8cm～6cm×15cm，6例以膝降动脉主干为血管蒂，5例以膝降动脉股内侧穿支为血管蒂，血管全部采用端端吻合。结果11例皮瓣全部存活，术后随访6～18个月，皮瓣外观及弹性良好，感觉恢复S3级。结论膝降动脉股内侧皮穿支血管解剖恒定，皮瓣厚薄适中，操作简便，是修复四肢远端皮肤缺损的较好方法。

Objective To investigate the feasibility of free descending genicular artery perforator flaps in the soft tissue defects at extremities. Methods Ten fresh cadavers were injected with lead oxidegelatin mixture for three-dimensional visualization reconstruction using a 16-slice spiral computed tomography scanner and specialized volume-rendering software （Materiaise＇s interactive medical image control system, MIMICS）. The origin, course and distribution of the perforators in the thigh and leg region were observed. 11 patients with skin defects at the distal part of extremities were treated. The flap size ranged from 5 cm×8 cm to 6 cm ×15 cm. Six flaps were pedicled with the descending genicular artery and the others were pedicled with the perforator of the descending genicular artery. All flaps were transferred by end to end anastomosis. Results The follow-up period ranged from 6 to 18 months. All the flaps survived. The appearance and texture of the flaps were good with sensory recovery of S3. Conclusions Free descending genicular artery perforator flap has a reliable blood supply and suitable thickness for the treatment of soft tissue defects at extremities. The technique is easily performed with reliable results.