基于美学理念的逆行股前外侧穿支皮瓣修复膝关节周围软组织缺损

摘要

Objective To investigate the clinical effect of the reserve-flow anterolateral thigh perforator flap based on aesthetics concept to repair soft tissue defect around the knee joint.Methods From June 2016 to April 2017, 10 patients with skin and soft tissue defects around the knee joint were admitted to Mingzhou Hospital of Zhejiang University. The area of the soft tissue defects around the ankle were ranged from 5. 0 cm × 3. 0 cm to 11. 0 cm × 7. 5 cm after debridement. The anterolateral thigh perforator flaps were designed on the ipsilateral lateral thigh, according to the results of preoperative perforator detection . The reserve-flow anterolateral thigh perforator flaps based on aesthetic concept were used to repair the wound through the subcutaneous tunnel. The flaps were 5. 5 cm × 3. 5 cm to 12. 0 cm × 8. 0 cm in size. The donor sites were directly closed. Results The flaps of 9 patients completely survived, however, epidermal necrosis occurred to 1 patient, at the distal end of the flap, about 1 cm × 1 cm in size. It completely healed after dressing change for 1 week. The follow up time was from 8 to 15 months ( mean 12 months) . The flaps were satisfactory in appearance, good in the elasticity, nearly normal in color, and had protective sensation. The two-point discrimination perception ranged from 9 to 13 mm( mean 10 mm) . The donor and recipient sites only remained linear scars, with no depression deformity. The lower limb functions were normal. Conclusions The reverse-flow anterolateral thigh flap based on aesthetic concept, is an alternative method to repair the soft tissue defect around the knee joint, and protect the donor site to the maximum extent.%目的 探讨采用基于美学理念的逆行股前外侧穿支皮瓣修复膝关节周围软组织缺损的临床疗效.方法 自2016年6月至2017年4月,浙江大学明州医院收治10例膝关节周围皮肤软组织缺损患者,扩创后创面面积5.0 cm×3.0 cm～11.0 cm×7.5 cm.根据术前穿支探测结果在同侧大腿外侧设计股前外侧穿支皮瓣,采用基于美学理念的逆行股前外侧穿支皮瓣经暗道修复创面,切取皮瓣面积为5.5 cm×3.5 cm～12.0 cm×8.0 cm.供区一期直接缝合.结果 本组共10例皮瓣,其中9例完全成活.1例远端出现约1 cm×1 cm大小表皮坏死,换药1周后完全愈合.所有患者均获8～15个月随访,平均12个月.皮瓣外观满意,弹性好,色泽接近正常,恢复了保护性感觉,皮瓣两点辨距觉9～13 mm,平均10 mm.供、受区仅残留线状瘢痕,无凹陷畸形,下肢功能正常.结论 基于美学理念的逆行股前外侧皮瓣在修复受区软组织缺损的同时最大程度地保护了供区,是修复膝关节围周皮肤软组织缺损的理想方式之一.