Department of Plastic, Reconstructive, Aesthetic and Hand Surgery (B.M.L., R.W., D.J.S., and D.F.K.) and Department of Angiology (D.S.), University Hospital Basel, Basel, Switzerland.
J Bone Joint Surg Am. 2018 Feb 7;100(3):211-217. doi: 10.2106/JBJS.16.01401.
The gastrocnemius muscle flap may be considered the first choice in many cases of soft-tissue reconstruction about the knee. Limited arc of rotation and reach of the flap as well as unsightly muscle bulk are major disadvantages and were the impetus to look for a local alternative. The aim of this study is to present a consecutive series of patients with a reconstruction about the knee involving the medial sural artery perforator flap (MSAPF).
A consecutive series of 17 cases of defect reconstructions about the knee using the MSAPF is described, with an emphasis on early postoperative complications.
No major flap-related complications occurred except 1 case of tip necrosis that healed uneventfully after excision and secondary suture. Two patients with direct donor-site closure had a minor complication that required no revision, and 2 had partial skin-graft loss.
In summary, use of this pedicled perforator flap represents a reliable technique for soft-tissue reconstruction about the knee with an acceptable complication rate and optimal contour reconstruction without the need for a skin graft and secondary debulking procedures. The range of motion associated with the MSAPF in comparison to the range associated with the gastrocnemius muscle flap is increased so that more proximal and lateral defects can be covered.
Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
在膝关节周围的软组织重建中，腓肠肌肌皮瓣可能被认为是许多情况下的首选。该皮瓣存在旋转和活动度有限、外观不美观等缺点，这促使我们寻找局部替代物。本研究旨在介绍一组使用腓肠神经营养血管皮瓣（MSAPF）进行膝关节重建的连续患者系列。
描述了使用 MSAPF 进行膝关节缺损重建的 17 例连续病例，重点介绍了术后早期并发症。
除 1 例尖端坏死外，无其他与皮瓣相关的主要并发症，经切除和二期缝合后愈合顺利。2 例直接关闭供区的患者出现轻微并发症，无需修复，2 例部分皮肤移植丢失。
总之，使用这种带蒂穿支皮瓣进行膝关节周围的软组织重建是一种可靠的技术，并发症发生率可接受，轮廓重建效果理想，无需皮片移植和二次缩容手术。与腓肠肌肌皮瓣相比，MSAPF 的活动度增加，因此可以覆盖更靠近近端和外侧的缺损。
治疗性 IV 级。有关证据水平的完整描述，请参阅作者说明。
