膝降动脉隐支皮瓣游离移植修复手部软组织缺损

Anatomy of the free saphenous branch of descending genicular artery flap and its clinical application for the hand soft-tissue defects

目的探讨游离膝降动脉隐支皮瓣修复手部软组织缺损的解剖学基础及临床效果。方法对15具尸体标本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。从2005年1月到2011年10月，临床应用膝内侧膝降动脉隐支皮瓣游离移植修复手部软组织缺损7例。皮瓣切取面积5．0cm×6．0cm-11．0cm×14．0cm，血管蒂长5．4（4．0—7．0）cm。结果膝降动脉隐支恒定存在，68％起自膝降动脉，32％直接发自股动脉。其起始部位在股骨内上髁上方9．0（4．0-16．0）cm，起始处外径平均为1．5（1．1～1．7）mm。7例皮瓣全部存活，平均随访28个月，皮瓣质地接近手部皮肤，部分感觉恢复，两点辨别觉8～12mm。结论膝降动脉隐支血管解剖恒定，皮瓣厚薄适中，操作简便，是修复手部皮肤缺损的较好办法。

Objective To provide anatomical basis for the free saphenous branch of descending genicular artery flap and evaluate its clinical outcomes for the hand soft-tissue defects. Methods Fifteen fresh cadavers injected with lead oxide-gelatin mixture for three-dimensional visualization reconstruction using a spiral computed tomography scanner. The origin, course and distribution of the perforators of descending genicular artery were observed. From January 2005 to October 2011, seven patients with skin defect on the distant limbs were treated. The flap size was 5 cm × 6 cm-11 cm× 14 cm,vascular pedicle length 5.4 （4- 7）cm. Results The saphenous branch was consistent. It arised from the descending genicular artery （68%） or femoral artery（32%）. The diameter of the saphenous branch was 1.5（1.1-1.7）mm at its origin above 9.0（4.0-16.0）cm from the medial epicondylar. Seven eases of flaps all survived, the average follow- up of 28 months, close to hand flap of skin texture, some sensory recovery, two-point discrimination 8-12 mm. Conclusion Free saphenous branch of descending genicular artery flap is a reliable option for the treatment of soft tissue defect in hands. The pedicles were invariable of anatomy, thickness of the flaps is comparable, and procedure is simple and time saving.