摘要
目的探讨大腿远端穿支蒂螺旋桨皮瓣转位修复膝关节周围软组织缺损创面的临床疗效。方法2009年1月-2019年10月,共收治膝关节周围软组织缺损72例,男43例,女29例,年龄17~83岁,缺损面积为4.0 cm×3.0 cm^22.0 cm×13.0 cm。根据大腿远端穿支蒂螺旋桨皮瓣的穿支血管的起源、走行、分支、分布和血管网吻合的解剖学依据,结合膝关节周围创面缺损部位、大小、形状等特点,设计穿支皮瓣并进行修复,其中应用股外侧远端穿支蒂螺旋桨皮瓣(LDF)9例,膝降动脉穿支蒂螺旋桨皮瓣(DGF)53例,腘窝直接动脉穿支蒂螺旋桨皮瓣(DPF)10例。皮瓣切取面积为4.5 cm×3.5 cm^24.0 cm×14.0 cm,供区直接缝合或游离全厚皮片覆盖。术后采取门诊随访(78%)、电话随访(15%)和微信随访(7%),评估患者创面修复的术后疗效和皮瓣早期、后期肿胀程度。结果本组72例皮瓣,其中65例术后全部成活,7例皮瓣远端边缘坏死(LDF 2例、DGF 4例、DPF 1例),给予换药处理,术后供、受区创面完全愈合。经3~72个月随访,修复后的膝关节不臃肿畸形,色泽、弹性与周围正常皮肤接近,皮瓣TPD为7~10 mm,创面愈合瘢痕较小。根据疗效评价:满意48例(其中LDF 4例、DGF 39例、DPF 5例)、一般24例(其中LDF 5例、DGF 14例、DPF 5例)。皮瓣肿胀程度评价:早期:Ⅰ度40例(其中LDF 4例、DGF 31例、DPF 5例)、Ⅱ度20例(其中LDF 3例、DGF 14例、DPF 3例)、Ⅲ度10例(其中LDF 2例、DGF 7例、DPF 1例)、IV度2例(其中DGF 1例、DPF 1例);后期:I度55例(其中LDF 6例、DGF 41例、DPF 8例)、Ⅱ度15例(其中LDF 2例、DGF 12例、DPF 1例)、Ⅲ度2例(其中LDF 1例、DPF 1例)。根据膝关节损害的功能评定:优17例(其中LDF 2例、DGF 12例、DPF 3例)、良35例(其中LDF 4例、DGF 27例、DPF 4例)、中20例(其中LDF 3例、DGF 14例、DPF 3例),总体优良率为73%,膝关节活动和稳定性基本正常,未发现膝部疼痛影响学习和生活。结论大腿远端穿支蒂螺旋桨皮瓣转位修复膝关节周围缺损创面,疗效可靠。
Objective To evaluate the clinical effect of soft tissue defects around knee joints repaired with thigh distal perforator propeller flap.Methods Clinical data of 72 patients with defects around knee joints from January,2009 to October,2019 were analyzed retrospectively,including 43 males and 29 females,aged from 17 to 83 years.The sizes of soft tissue defects ranged from 4.0 cm×3.0 cm to 22.0 cm×13.0 cm.Perforator propeller flaps were designed and harvested to repair the defects according to anatomical features of the origin,course,branches,distribution and anastomosis of vascular network of the perforator vessels and location as well as the size and shape of defects.Nine patients repaired with the lateral distal perforator propeller flaps(LDF),53 with descending genicular artery perforator propeller flaps(DGF)and 10 with direct popliteal artery perforator propeller flaps(DPF).The size of flap was 4.5 cm×3.5 cm to 24.0 cm×14.0 cm.The donor sites were sutured directly or covered with free full-thickness skin.To evaluate the effect,the skin swelling rating in early and later stage were taken.Three to 72 months of followed-up was conducted through outpatient clinic(78%),telephone(15%)and WeChat(7%).Results The flaps totally survived in 65 patients and 7 patients underwent partial necrosis at the distal end of the flaps(2 cases of LDF,4 cases of DGF,1 case of DPF)who were treated with dressing,and the donor sites were completely healed.The appearance and shape of the repaired knee joints was good,and the color and elasticity was close to surrounding normal skin,TPD of the flaps were 7-10 mm,and the scar was small after 3 to 72 months'follow-up.The efficacy was satisfactory in 48 cases(4 cases of LDF,39 cases of DGF,5 cases of DPF),general in 24 cases(5 cases of LDF,14 cases of DGF,5 cases of DPF).Degree of flap swelling:in early stage,Ⅰ°in 40 cases(4 cases of LDF,31 cases of DGF,5 cases of DPF),Ⅱ°in 20 cases(3 cases of LDF,14 cases of DGF,3 cases of DPF),Ⅲ°in 10 cases(2 cases of LDF,7 cases of DGF,1 case of DPF),IV°in 2 cases(1 case of DGF,1 case of DPF);in later stage:I°in 55 cases(6 cases of LDF,41 cases of DGF,8 cases of DPF),Ⅱ°in 15 cases(2 cases of LDF,12 cases of DGF,1 case of DPF),Ⅲ°in 2 cases(1 case of LDF,1 case of DPF).The evaluation of knee joint function:excellent in 17 cases(2 cases of LDF,12 cases of DGF,3 cases of DPF),good in 35 cases(4 cases of LDF,27 cases of DGF,4 cases of DPF),general in 20 cases(3 cases of LDF,14 cases of DGF,3 cases of DPF).The good rate was about 73%.The range of motion and stability of the knee joint were basically normal and there was no pain found to affect study and life.All the patients were satisfied with the effect.Conclusion Repairing soft tissue defect around knee joint with thigh distal perforator propeller flap is reliable and clinical applicable.
作者
林涧
吴立志
刘蔡钺
张天浩
王之江
张娟
LIN Jian;WU Lizhi;LIU Caiyue;ZHANG Tianhao;WANG Zhijiang;ZHANG Juan(Department of Orthopedics,Wound Prevention and Treatment Research Center,Xinhua Hospital(Chongming)Affiliated to Medical College,Shanghai Jiaotong University,Shanghai 202150,China;Department of Hand and Foot Surgery,Taizhou Hospital of Zhejiang Province,Wenzhou Medical University,Taizhou,Zhejiang Province 317000,China;Department of Plastic and Burn Surgery,Changzheng Hospital,Navy Medical University,Shanghai 200003,China)
出处
《中华显微外科杂志》
CSCD
北大核心
2020年第3期227-232,共6页
Chinese Journal of Microsurgery
基金
上海市科研计划项目(14411973200)
上海市卫生和计划生育委员会科研课题(201840198)。
关键词
膝
螺旋桨皮瓣
穿支皮瓣
膝降动脉
腘窝直接动脉
修复
Knee
Propeller flap
perforator flap
Descending genicular artery
Direct popliteal artery
Repair
