Ruan Hongjiang, Cai Peihua, Fan Cunyi, Chai Yimin, Liu Shenghe
Department of Orthopaedics, the Sixth People's Hospital, Shanghai Jiao Tong University, Shanghai, 200233, PR China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2009 Mar;23(3):303-5.
To investigate the operative technique and clinical results of repairing the soft tissue defects of knee with antegrade extended peroneal artery perforator flap.
From October 2007 to January 2008, 3 patients (2 men and 1 woman) with the soft tissue defects of knee were treated, with the ages of 18, 31 and 42 years, respectively. The first case sustained femur and pelvis fractures and soft tissue defect over his right popliteal fossa, which were treated with open reduction and internal fixation (ORIF) and debridement of knee joint 2 weeks ago. The second case was necrosis of skin 3 weeks after ORIF for fracture of tibial plateau. The third case suffered from open fracture of tibial plateau and soft tissue defect, which were treated with external fixation and debridement 3 weeks ago. The defect sizes were 16 cm x 9 cm, 11 cm x 6 cm and 14 cm x 7 cm. The flap was raised by dividing the peroneal artery and veins distally and elevating them proximally, which covered for the defects of knee. The flaps were designed with the size of 18 cm x 10 cm, 12 cm 7 cm and 15 cm x 8 cm. The pure vascular pedicle of the flap was 10 cm to 17 cm in length, including the peroneal vessels and one or two perforator branches. The donor site is covered by a split thickness skin graft.
All flaps survived after surgery. The donor sites healed by first intention and the skin grafts survived. After following up for 6, 8 and 11 months, the appearance and function of the flaps were all satisfactory. Based on the modified HSS knee performance system, post-operative knee functional outcomes of three patients were excellent.
The antegrade extended peroneal artery perforator flap supplied by a pure vascular pedicle can be a good alternative for reconstruction of knee. The flap, with a long and thin pure vascular pedicle, could provide good texture and contour matching the recipient area.
探讨顺行腓动脉穿支皮瓣修复膝关节软组织缺损的手术技巧及临床效果。
2007年10月至2008年1月，治疗3例膝关节软组织缺损患者，其中男性2例，女性1例，年龄分别为18岁、31岁和42岁。第1例患者右腘窝处股骨和骨盆骨折伴软组织缺损，2周前行切开复位内固定术（ORIF）及膝关节清创术。第2例患者胫骨平台骨折行ORIF术后3周出现皮肤坏死。第3例患者胫骨平台开放性骨折伴软组织缺损，3周前行外固定及清创术。缺损大小分别为16 cm×9 cm、11 cm×6 cm和14 cm×7 cm。皮瓣通过在远端离断腓动静脉并向近端掀起，覆盖膝关节缺损。皮瓣设计大小分别为18 cm×10 cm、12 cm×7 cm和15 cm×8 cm。皮瓣纯血管蒂长度为10 cm至17 cm，包括腓血管及1至2支穿支分支。供区采用中厚皮片移植覆盖。
术后所有皮瓣均存活。供区一期愈合，皮片成活。随访6个月、8个月和11个月后，皮瓣外观及功能均满意。根据改良的HSS膝关节功能评分系统，3例患者术后膝关节功能均为优。
由纯血管蒂供血的顺行腓动脉穿支皮瓣是膝关节重建的良好选择。该皮瓣血管蒂细长，可为受区提供良好的质地和外形匹配。
