膝降动脉穿支皮瓣应用于膝周软组织缺损创面修复的效果分析

Application of perforator flap of descending knee artery in repairing soft tissue defects around knee

目的研究膝降动脉穿支皮瓣在膝周软组织缺损创面修复中的应用及临床效果。方法回顾性分析2017年8月-2021年8月解放军联勤保障部队第九一○医院烧伤整形科应用膝降动脉穿支皮瓣修复膝周软组织缺损创面32例的临床资料,其中男18例,女14例,年龄15~66岁,入院时间为伤后2 h~15 d,穿支皮瓣面积5.0 cm×8.0 cm~10.0 cm×15.0 cm,供瓣区均直接缝合。结果本组32例患者皮瓣成活良好,仅1例患者皮瓣远端约1.0 cm×2.0 cm表皮坏死,经换药后治愈,创面愈合时间14~27 d;随访6~12个月,皮瓣质地柔软,31例膝关节活动恢复良好,下肢未出现肿胀及静脉回流不佳情况,4例患者因皮瓣稍臃肿再次入院行皮瓣修薄术,1例患者因膝关节功能锻炼不足致膝关节僵硬,行走不便。结论膝降动脉穿支皮瓣在修复膝周软组织缺损创面中能起到满意的效果,且手术不须吻合血管,术后外观及功能较好,供瓣区往往可直接缝合,不损伤膝周正常皮肤组织。

Objective To study the application and clinical effect of perforator flap of descending genicular artery in repairing soft tissue defect around knee.Methods From August 2017 to August 2021,32 cases of soft tissue defects around the knee were repaired with perforator flap of descending genicular artery,including 18 males and 14 females,aged 15-66 years.The admission time was 2 h-15 d after injury.The perforator flap area was 5.0 cm×8.0 cm-10.0 cm×15.0 cm,and the donor area was sutured directly.Results The flaps of 32 patients survived well,but only one patient had skin necrosis of about 1.0 cm×2.0 cm at the distal end,which was cured after dressing change,and the wound healing time was 14-27 days.Follow-up for 6-12 months showed that the skin flap was soft,31 cases of knee joint recovered well,and no swelling or poor venous return occurred in the limbs.Four patients were hospitalized again for skin flap thinning because of slightly bloated skin flap.And one patient had knee joint stiffness and walking inconvenience due to insufficient functional exercise of knee joint.Conclusion The perforator flap of descending genicular artery can achieve good results in repairing soft tissue defects around the knee.There is no need to anastomose blood vessels in the operation.The appearance and function of the flap donor site are good after the operation.The flap donor site can often be sutured directly without damaging the normal skin tissue around the knee.