Luca-Pozner Vlad, Delgove Anais, Kerfant Nathalie, Karra Amir, Herlin Christian, Chaput Benoit
From the Department of Plastic, Reconstructive Surgery and Burns, Armand Trousseau Hospital, Paris.
Plastic Surgery, Hand Surgery and Burns Unit, FX Michelet Center, University Hospital of Bordeaux, Bordeaux.
Ann Plast Surg. 2020 Dec;85(6):650-655. doi: 10.1097/SAP.0000000000002356.
For soft-tissue defect coverage in the lower leg and around the knee joint, the gastrocnemius muscle flap is the most commonly used. Having constant anatomy, a long pedicle, and decreased donor site morbidity, the medial sural artery perforator (MSAP) flap may represent a good reconstructive alternative. The aim of this report was to present the experience of using a dual perforator MSAP pedicled flap.
Nineteen patients underwent soft-tissue reconstruction by MSAP flap in the one third of the lower leg and around the knee joint. Eleven patients were injured in traffic accidents. Exposure of a knee prosthesis required flap coverage in 4 cases. The other defect etiologies were a gunshot wound, bone abscess due to a sickle cell anemia, bone exposure due to a full thickness burn, and sarcoma resection. Defect dimensions ranged from 7 × 5 cm to 15 × 8 cm. Seventeen flaps were harvested with 2 perforators. Donor sites were closed primary in 16 of the 19 cases.
The sizes of the MSAP flaps ranged from 7 to 22 cm × 5 to 8 cm. The procedure was uneventful in 17 cases. The 2 unsuccessful flaps developed a distal necrosis, for which an excision with direct suture was made secondary. Complete healing was achieved in all cases.
The pedicled MSAP flap represents a versatile option in soft-tissue defect coverage of the lower leg and around the knee joint. Inclusion of 2 perforators could render the flap safer and increase its skin paddle, making it suitable for larger defects.
对于小腿及膝关节周围的软组织缺损覆盖，腓肠肌肌瓣是最常用的。腓肠内侧动脉穿支（MSAP）瓣具有恒定的解剖结构、较长的蒂且供区并发症减少，可能是一种很好的重建选择。本报告的目的是介绍使用双穿支MSAP蒂瓣的经验。
19例患者在小腿下三分之一及膝关节周围接受了MSAP瓣软组织重建。11例患者因交通事故受伤。4例因膝关节假体暴露需要瓣覆盖。其他缺损病因包括枪伤、镰状细胞性贫血导致的骨脓肿、全层烧伤导致的骨外露以及肉瘤切除。缺损尺寸范围为7×5 cm至15×8 cm。17个瓣采用2个穿支进行切取。19例中有16例供区一期缝合关闭。
MSAP瓣大小范围为7至22 cm×5至8 cm。17例手术过程顺利。2例未成功的瓣发生远端坏死，随后进行了切除并直接缝合。所有病例均实现完全愈合。
带蒂MSAP瓣是小腿及膝关节周围软组织缺损覆盖的一种多功能选择。包含2个穿支可使瓣更安全并增加其皮瓣面积，使其适用于更大的缺损。
