Lu Lai-Jin, Gong Xu, Cui Jian-Li, Liu Bin
Department of Hand Surgery, The First Hospital of Ji Lin University, Chang Chun, Ji Lin Province, People's Republic of China.
Ann Plast Surg. 2011 Sep;67(3):275-8. doi: 10.1097/SAP.0b013e3181f89151.
Skin defects around the knee remain a challenge for the reconstructive surgeons. Choosing appropriate flaps for coverage is crucial to preserve the knee joint or to restore its function. On the basis of anatomic results in 20 cadaveric specimens, we found a constant supragenicular fasciocutaneous perforator within 3 cm above the adductor tubercle, which arose from the saphenous branch of the descending genicular artery. Based on it, the distally pedicled anteromedial thigh fasciocutaneous flap can be harvested from the anteromedial thigh. Between 2003 and 2009, we performed the distally pedicled anteromedial thigh flaps in 11 patients. The site of skin defects included the popliteal fossa, proximal ⅓ leg, and amputation stump below knee. The size of skin defects ranged from 15 × 6 cm to 27 × 9 cm, and the corresponding size of the flaps ranged from 15 × 10 cm to 32 × 9 cm. Of 11 flaps, 10 flaps survived unevently, except 1 flap which suffered partial necrosis due to venous congestion. The patients were followed up for 3 weeks to 12 months. The donor site healed uneventfully without complications in all patients. Additionally, the skin paddle matched with the recipient in terms of skin color, texture, and thickness. The anteromedial thigh fasciocutaneous flap pedicled on the supragenicular perforator is a reliable and versatile alternative to cover skin defects around the knee.
膝关节周围的皮肤缺损对重建外科医生来说仍然是一项挑战。选择合适的皮瓣进行覆盖对于保留膝关节或恢复其功能至关重要。基于对20具尸体标本的解剖结果，我们发现在内收肌结节上方3厘米范围内有一个恒定的膝上筋膜皮肤穿支，它起源于膝降动脉的隐支。基于此，可以从大腿内侧前部切取带蒂逆行大腿内侧筋膜皮瓣。在2003年至2009年期间，我们对11例患者实施了带蒂逆行大腿内侧皮瓣手术。皮肤缺损部位包括腘窝、小腿近端1/3以及膝下截肢残端。皮肤缺损大小从15×6厘米至27×9厘米不等，相应的皮瓣大小从15×10厘米至32×9厘米不等。11个皮瓣中，除1个因静脉淤血发生部分坏死外，其余10个皮瓣均顺利存活。对患者进行了3周至12个月的随访。所有患者供区均顺利愈合，无并发症发生。此外，皮瓣的皮岛在肤色、质地和厚度方面与受区匹配。以膝上穿支为蒂的大腿内侧筋膜皮瓣是覆盖膝关节周围皮肤缺损的一种可靠且通用的选择。
