Zheng He-Ping, Zhuang Yue-Hong, Lin Jian, Zhang Yi Xin, Levin L Scott, Grassetti Luca, Lazzeri Davide, Persichetti Paolo
Clinical Anatomic Center, Fuzhou, General Hospital of People's Liberation Army, Nanjing District, Fuzhou, Fujian, China.
Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai JiaoTong University School of Medicine, Shanghai, China.
Microsurgery. 2015 Jul;35(5):370-9. doi: 10.1002/micr.22340. Epub 2014 Oct 18.
In this article,we revisited the anatomy of the distal perforator of the descending genicular artery (DGA) and report the clinical application of its perforator propeller flap in the reconstruction of soft tissue defects around the knee.
Forty fresh human lower limbs were dissected to redefine the anatomy of the branches of the DGA and their perforators and the anatomical landmarks for clinical applications. Five patients underwent "propeller" distal anteromedial thigh (AMT) flaps based on DGA perforators for the reconstruction of post-traumatic (n = 4) and post-oncologic (n = 1) soft tissue defects occurring near the knee with a size ranging from 4.8 cm × 6.2 cm to 10.5 cm × 18.2 cm.
A constant cutaneous perforator of the osteoarticular branch (OAB) of the DGA was found in the distal AMT fossa with a mean caliber of 1.2 ± 0.4 mm. It arose 9.4 ± 3.1 cm distally to the origin of the OAB and 4.0 ± 0.4 cm above the knee joint. The size of the harvested flaps ranged from 6.0 cm × 7.1 cm to 11.0 cm × 20.1 cm. All the flaps healed uneventfully at a mean period of 7.4 months. All the patients regained full range motion of the knee-joint.
Our study provided evidence of the vascular supply and the clinical application of the distal AMT flap based on a constant perforator arising from the OAB of the DGA. This flap may be a versatile alternative for the reconstruction of the defects around the knee because of its consistent vascular pedicle, pliability and thinness, adequate retrograde perfusion, and the possible direct suture of the donor site.
在本文中，我们重新审视了膝降动脉（DGA）远端穿支的解剖结构，并报告其穿支推进皮瓣在膝关节周围软组织缺损重建中的临床应用。
解剖40条新鲜人体下肢，重新界定DGA分支及其穿支的解剖结构以及临床应用的解剖标志。5例患者接受了基于DGA穿支的“推进”大腿远端前内侧（AMT）皮瓣，用于重建膝关节附近创伤后（n = 4）和肿瘤切除后（n = 1）的软组织缺损，缺损大小为4.8 cm×6.2 cm至10.5 cm×18.2 cm。
在大腿远端前内侧窝发现DGA骨关节支（OAB）恒定的皮穿支，平均管径为1.2±0.4 mm。它起自OAB起始部远端9.4±3.1 cm处，膝关节上方4.0±0.4 cm处。切取皮瓣大小为6.0 cm×7.1 cm至11.0 cm×20.1 cm。所有皮瓣均顺利愈合，平均愈合时间为7.4个月。所有患者膝关节均恢复了全范围活动。
我们的研究提供了基于DGA的OAB恒定穿支的大腿远端前内侧皮瓣血供及临床应用的证据。由于其血管蒂恒定、柔韧性好、薄、逆行灌注充分以及供区可能直接缝合，该皮瓣可能是膝关节周围缺损重建的一种通用替代方法。
