多种形式股前外侧穿支瓣修复膝周复杂性创面

Various Forms of Anterolateral Thigh Perforating Flaps for Repairing Complex Wounds around Knee

目的探讨多种形式股前外侧穿支蒂组织瓣修复膝周复杂性创面的临床效果。方法2013年3月至2019年6月共收治各种原因导致的膝及周围皮肤软组织缺损、骨及关节外露的患者26例,彻底清创或行肿瘤切除后根据创面特点,采用多种形式的远端蒂股前外侧穿支皮瓣、筋膜瓣、肌皮瓣和远端穿支蒂股前外侧螺旋桨皮瓣修复。创面大小为(8 cm×5 cm)~(19 cm×10 cm),皮瓣面积(9 cm×6 cm)~(19 cm×11 cm)。结果本组采用远端蒂旋股外侧血管降支穿支皮瓣11例,远端蒂旋股外侧血管降支穿支阔筋膜皮瓣6例(其中2例行髌韧带重建),远端蒂旋股外侧血管降支穿支肌皮瓣4例,皮瓣、肌皮瓣大小为(9 cm×6 cm)~(18 cm×10 cm);采用旋股外侧血管降支远端穿支蒂螺旋桨皮瓣3例,远端蒂旋股外侧血管降支穿支和远端穿支双血供股前外侧皮瓣2例,皮瓣大小为(11 cm×6 cm)~(19 cm×11 cm)。本组皮瓣全部成活23例,皮瓣远端出现部分坏死3例,经换药后逐渐愈合。随访6~24个月,体表恶性肿瘤患者未见肿瘤复发,无一例骨感染发生,行髌韧带重建的2例患者功能良好。全组患者皮瓣及供瓣区外形良好,所有患者均对手术效果满意。结论多种不同形式的股前外侧穿支蒂组织瓣血供可靠、切取方便,对供区影响小,不需牺牲主要血管,是修复膝周皮肤软组织缺损及膝功能重建的理想方法之一,临床应用时应根据膝周组织缺损具体状况及穿支形式进行选择。

Objective To explore the clinical effect of various forms of anterolateral thigh perforator pedicle flaps for repairing peri-knee complex wound surface.Methods From March 2013 to June 2019,a total of 26 patients with skin and soft tissue defects of knee and peri-knee,bone and joint exposure caused by various reasons were treated by debridement or tumor resection,various forms of pedicle anterolateral thigh perforator flap grafting according to the characteristics of the wound surface.The size of the wound surface ranged from 8 cm×5 cm to 19 cm×10 cm,and the area of the skin flap ranged from 9 cm×6 cm to 19 cm×11 cm.Results Distal pedicled lateral femoral circumflex perforating branch flap was performed in 11 cases,distal pedicled lateral femoral circumflex perforating branch fascia latacutaneous flap was in 6 cases(including 2 cases underwent patellar ligament reconstruction),distal pedicled perforator musculocutaneous flaps with descending branch of lateral femoral circumflex vessels was in 4 cases,and the size of the flaps and musculocutaneous flaps ranged from 9 cm×6 cm to 18 cm×10 cm;the distal pedicled perforator propeller skin flap with the descending branch of the lateral femoral circumflex blood vessel was in 3 cases,anterolateral femoral skin flaps with dual blood supply of both the distal pedicled descending branch of the lateral femoral circumflex blood vessel and the distal perforator in 2 cases,and the size of the flaps ranged from 11 cm×6 cm to 19 cm×11 cm.All flaps survived in 23 cases,and partial necrosis at the distal end of the flap was found in 3 cases,which gradually healed after dressing changes.During the follow-up period of 6 to 24 months,there was no tumor recurrence in the patients with surface malignant tumors,and no osteomyelitis occurred.The 2 patients who underwent patel-lar ligament reconstruction functioned well.The skin flaps and donor valve area were in good shape in all cases.All patients were satisfied with the results of the surgery.Conclusions Various forms of anterolateral thigh perforator tissue flaps are one of the ideal methods for repairing skin and soft tissue defects around the knee and reconstruction of knee function with reliable blood supply,convenient harvest,mini-trauma of the donor site and without sacrificing major blood vessels.The anterolateral thigh perforator tissue flaps could be selected accord-ing to the specific condition of the knee tissue defect and the form of perforator.