腘窝外侧动脉穿支链型皮瓣修复腘窝瘢痕的临床应用

CLINICAL APPLICATION OF LINK-PATTERN LATERAL POPLITEAL ARTERY PERFORATOR FLAP IN REPAIR OF POPLITEAL FOSSA SCAR

目的探讨腘窝外侧动脉穿支链型皮瓣修复儿童或青少年腘窝瘢痕挛缩的可行性及疗效。方法2009年1月-2013年1月,收治12例腘窝瘢痕患者。男7例,女5例;年龄3~17岁,中位年龄12岁。病程6个月~5年,中位时间3年。采用腘窝外侧动脉穿支链型皮瓣修复腘窝瘢痕松解后创面,创面范围6 cm×4 cm^10 cm×7 cm,皮瓣切取范围7 cm×4 cm^12 cm×9 cm;皮瓣携带腓肠外侧皮神经5例,保留腓肠外侧皮神经于供区7例;供区采用游离断层皮片植皮修复。结果术后皮瓣均顺利成活,创面Ⅰ期愈合;供区植皮成活,切口均Ⅰ期愈合。12例均获随访,随访时间12~36个月,平均18个月。皮瓣色泽、质地、外形良好,无臃肿;瘢痕增生明显软化,无增生及破溃;患者无跛行,膝关节活动度达0~180°,下蹬正常。小腿供区植皮平整,无凹陷或瘢痕增生。皮瓣携带皮神经者小腿后下部及足背外侧部分感觉减退或消失;术后6个月两点辨别觉12~14 mm,平均13 mm。保留皮神经于供区者小腿后外侧早期有麻木不适感,但3~6个月后感觉明显恢复,无感觉缺失;术后6个月两点辨别觉5~7 mm,平均6 mm。结论腘窝外侧动脉穿支链型皮瓣血供可靠,手术操作简便,切取时可将皮神经保留于供区,是修复儿童或青少年腘窝瘢痕松解后创面的理想方法之一。

Objective To discuss the feasibility and effectiveness of link-pattern lateral popliteal artery perforator flap in repairing popliteal fossa scar contracture in children or teenagers. Methods Between January 2009 and January 2013, 12 patients with popliteal fossa scar were admitted. Of them, 7 cases were male and 5 cases were female, aged from 3 to 17 years（median, 12 years）. The disease duration was from 6 months to 5 years（median, 3 years）. Wound was repaired with link-pattern lateral popliteal artery perforator flap after remission of popliteal fossa scar. The wound ranged from 6 cm × 4 cm to 10 cm × 7 cm, and the flap size ranged from 7 cm × 4 cm to 12 cm × 9 cm. The flap was with lateral sural cutaneous nerve in 5 cases, and lateral sural cutaneous nerve was retained at the donor area of 7 cases. The donor site was repaired using splitthickness skin graft. Results All pedicled flaps and skin graft survived smoothly after operation. The wound at donor site healed by first intention. All the cases were followed up 12-36 months, with an average of 18 months. The flaps had good color, texture, and shape; scar obviously became softened, without hyperplasia or ulceration. The patients were free from lameness with knee range of motion of 0-180°. The squatting function was normal. Grafting skin was smooth in the donor area of the calf, without depression or scar hyperplasia. The senses of posterior-inferior calf and lateral of foot decreased or disappeared in 5 cases of flaps with lateral sural cutaneous nerve; at 6 months after operation, two-point discrimination was 12-14 mm（mean, 13 mm）. The posterior-inferior calf was numb and discomfort in 7 cases of flaps with retained lateral sural cutaneous nerve; but after 3-6 months, the sense was obviously recovered, with no sense loss; at 6 months after operation, two-point discrimination was 5-7 mm（mean, 6 mm）. Conclusion Link-pattern lateral popliteal artery perforator flap has reliable blood supply and the operation was simple. The cutaneous nerve can be retained in donor area. It is an ideal method for repairing wound after remission of popliteal fossa scar in children or teenagers.