Rad Ariel N, Christy Michael R, Rodriguez Eduardo D, Brazio Philip, Rosson Gedge D
Division of Trauma Plastic Surgery, R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, MD, USA.
Ann Plast Surg. 2010 Feb;64(2):210-6. doi: 10.1097/SAP.0b013e3181a13dd6.
Soft-tissue reconstruction of traumatic patella and proximal tibial defects is challenging. Pedicled perforator-based adipocutaneous rotation flaps are a versatile local option as they have axial perfusion and greater freedom of transposition compared with random-pattern flaps, and replace the ideal tissue properties of this anatomic region.
Anatomic dissections were performed on 15 fresh cadaver legs and location of the dominant perforator measured. Clinical: A retrospective review was conducted at the University of Maryland/R Adams Cowley Shock Trauma Center evaluating patients over a 3-year period.
Cadaver dissections confirmed a principal perforator at 11.4 +/- 1.6 cm inferior to the patella. This vessel is consistently suitable in length and caliber for large rotation flap design. Clinical: Anterior tibial artery perforator flaps were performed on 4 patients following Gustilo IIIB wounds to the patella and tibial plateau. Two patients had rotation flap reconstructions to salvage failed gastrocnemius muscle flaps. All flaps were successful, however, one patient had overwhelming hardware infection several months later despite successfully healed flap.Local anterior tibial artery perforator flaps based on predictable perforators provide reliable coverage of patella and knee defects, bestowing versatility and flexibility to the reconstructive surgeon's armamentarium.
创伤性髌骨和胫骨近端缺损的软组织重建具有挑战性。带蒂穿支脂肪皮瓣是一种多功能的局部选择，因为与随意皮瓣相比，它们具有轴向血供且转移自由度更大，并且能替代该解剖区域的理想组织特性。
对15条新鲜尸体下肢进行解剖，测量主要穿支的位置。临床：在马里兰大学/R·亚当斯·考利休克创伤中心进行回顾性研究，评估3年内的患者。
尸体解剖证实，主要穿支位于髌骨下方11.4±1.6厘米处。该血管在长度和管径上始终适合大型旋转皮瓣设计。临床：对4例髌骨和胫骨平台 Gustilo IIIB 级创伤的患者实施了胫前动脉穿支皮瓣手术。2例患者采用旋转皮瓣重建术挽救失败的腓肠肌皮瓣。所有皮瓣均成功，但1例患者尽管皮瓣成功愈合，数月后仍发生严重的内固定感染。基于可预测穿支的局部胫前动脉穿支皮瓣能可靠地覆盖髌骨和膝关节缺损，为重建外科医生的工具库增添了多功能性和灵活性。
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