隐动脉穿支皮瓣修复膝前软组织缺损髌骨外露

Repair of anterior soft tissue defect of knee joint with patella exposure by saphenous artery perforator flap

目的探讨隐动脉穿支皮瓣修复膝前软组织缺损髌骨外露的临床治疗效果。方法2010年7月至2017年9月,华北理工大学附属唐山骨科医院手二科收治12例膝前软组织缺损髌骨外露患者,男8例,女4例,年龄24~60岁,平均42.6岁。致伤原因:车祸伤5例,碾轧伤3例,烧烫伤2例,髌骨骨折术后2例。创面范围6 cm×5 cm~8 cm×7 cm。切取面积为7 cm×6 cm~9 cm×8 cm的隐动脉穿支皮瓣修复创面,供区均游离植皮修复。观察术后效果,并按照英国医学研究会评定标准评价皮瓣感觉功能。结果12例皮瓣全部成活,创面一期愈合,均无术后并发症。12例术后随访6~24个月,平均12个月,皮瓣色泽、质地良好,外观较佳,皮瓣厚薄适中,膝关节功能恢复良好,皮瓣感觉:2例S_(3)^(+)级,6例S_(3)级,4例S_(2)级。结论隐动脉穿支皮瓣穿支血管解剖位置较恒定、切取方法简单,皮瓣血供丰富,可切取皮瓣面积较大,对皮瓣供区损伤较小,是修复膝前软组织缺损髌骨外露的一种有效方法。

Objective To investigate the clinical effect of saphenous artery perforating branch flap in repairing anterior knee soft tissue defects with patella exposure.Methods From July 2010 to September 2017,12 patients whose patella exposed due to anterior soft tissue defects of knee were treated.The 12 cases included 8 males and 4 females,aged from 24 to 60 years(42.6 years on average).The causes of injury included car accident in 5 cases,rolling injury in 3 cases,burn and scald in 2 cases,and postoperative patella fracture in 2 cases.The areas of the wounds ranged from 6 cm×5 cm to 8 cm×7 cm.The wounds were repaired by saphenous artery perforating flaps with the area ranged from 7 cm×6 cm to 9 cm×8 cm,and the donor sites were repaired with free skin grafting.Results All the 12 cases ended up with the wounds healed primarily and no postoperative complications.The 12 cases were followed up for 6 months to 24 months,with an average of 12 months.The color,texture and appearance of the flaps were good,the thickness of the flap were moderate,and the function of knee joint was recovered well.Skin flap sensation was graded according to the criteria of the British Medical Research Society:2 cases for Grade S_(3)^(+),6 cases for Grade S_(3) and 4 cases for Grade S_(2).Conclusions Saphenous artery perforating flap is an effective method to repair anterior knee soft tissue defect and patella exposure.