腓肠肌皮瓣防治全膝关节置换术切口并发症

Gastrocnemius myocutaneous flap for incision complications of complex total knee arthroplasty

[目的]探讨腓肠肌皮瓣应用于复杂全膝关节置换术(total knee arthroplasty, TKA)后切口并发症的防治临床结果。[方法]回顾性分析2014-2019年本科收治的应用同侧腓肠肌皮瓣处理复杂TKA切口的12例患者。其中,4例为预防性肌皮瓣移植覆盖切口,其余8例为挽救性肌皮瓣闭合切口。比较两组围手术期、随访与实验室检查资料。[结果]两组患者均顺利完成手术,术中均无重要血管、神经损伤等严重并发症。预防性组术后下地行走时间、拆线时间和住院时间均显著优于挽救性组(P<0.05)。预防性组4例切口均甲级愈合;挽救性组7例甲级愈合,1例乙级愈合。两组共12例患者出院至末次随访均未发生手术部位局部感染、皮肤坏死或翻修手术。末次随访时,预防性组KSS评分和ROM均优于挽救性组,其中两组间KSS评分的差异有统计学意义(P<0.05)。实验室检查方面,除了CRP在肌皮瓣术后2周时预防组低于挽救组的差异有统计学意义(P<0.05),其余的差异均无统计学含义(P>0.05)。[结论]腓肠肌皮瓣转位覆盖伤口可以有效预防及治疗复杂TKA切口并发症。相比之下,采用预防性肌皮瓣的临床效果优于挽救性肌皮瓣。

[Objective] To explore the clinical outcomes of gastrocnemius myocutaneous flap for prevention and treatment of incision complications of complex total knee arthroplasty(TKA). [Methods] A retrospective study was conducted on 12 patients who received gastrocnemius myocutaneous flap for incision complications of complex TKA. Of them, 4 patients received prophylactic myocutaneous flap,while the remaining 8 patients had salvage myocutaneous flap. The two groups were compared regarding perioperative and follow-up data,as well as laboratory tests. [Results] The patients in both groups had operations performed smoothly without serious complications, such as iatrogenic injury to important blood vessels and nerves. The prophylactic group proved significantly superior to the salvage group in the time to return ambulation, time to remove stitches and hospital stay(P<0.05). All the 4 patients in the prophylactic group got primary incision healing, whereas 7 patients had Grade A and 1 had Grade B incision healing in the salvage group secondary to myocutaneous flap transfer. To the latest follow up, no recurrence of local infection, skin necrosis or revision surgical intervention happened in any patient of both groups. At the final interview, the prophylactic group was superior to the salvage group in KSS score and extension-flexion range of motion(ROM) of the affected knee, with a statistical significance in the KSS score between them(P<0.05). With regard to laboratory test,there were no statistical differences between the two group regarding ESR and CRP at 4 weeks after operation(P>0.05). [Conclusion]Transfer of ipsilateral gastrocnemius myocutaneous flap to cover the wound does effectively prevent and treat incision complications of complex TKA. By comparison, the prophylactic flap is superior to the salvage flap in clinical consequences.