Tiengo C, Macchi V, Porzionato A, Stecco C, Vigato E, Azzena B, Parenti A, De Caro R
Section of Plastic Surgery, Department of Medical and Surgical Sciences, School of Medicine, University of Padova, Via A. Gabelli 65, 35127 Padova, Italy.
Section of Anatomy, Department of Human Anatomy and Physiology, School of Medicine, University of Padova, Via A. Gabelli 65, 35127 Padova, Italy. E-mail address for R. De Caro:
JBJS Essent Surg Tech. 2011 Jun 15;1(1):e5. doi: 10.2106/JBJS.ST.K.00007.
To treat severe soft-tissue complications of total knee arthroplasty, we used an extended reversed gracilis flap based on secondary pedicles (the GReSP flap).
STEP 1 PREPARE WOUND BED: Locate the gracilis and pedicles, then debride the wound bed.
STEP 2 EXPOSE GRACILIS MUSCLE: Expose the superficial aspect of the muscle, while protecting the saphenous vein and nerve.
STEP 3 CHECK MUSCLE PERFUSION: Temporarily clamp the main vascular pedicle to ensure blood supply when perfused only by the secondary pedicles.
STEP 4 MOBILIZE MUSCLE FLAP: Transect the proximal tendon of the gracilis muscle to provide maximal length for the muscle flap and ligate the main vascular and nerve pedicles.
STEP 5 COVER WITH SKIN GRAFT: Suture the flap in place and cover with skin graft.
STEP 6 POSTOPERATIVE CARE: Immobilize the knee for two weeks; follow with rehabilitation to restore range of motion.
RESULTS & PREOP/POSTOP IMAGES: We treated three patients who had an infection at the site of a total knee arthroplasty and exposure of the implant.
IndicationsContraindicationsPitfalls & Challenges.
为治疗全膝关节置换术后严重的软组织并发症，我们采用了基于二级蒂的延长股薄肌逆行皮瓣（GReSP皮瓣）。
步骤1 准备创面床：确定股薄肌和蒂，然后清创创面床。
步骤2 显露股薄肌：显露肌肉的浅面，同时保护大隐静脉和神经。
步骤3 检查肌肉灌注：临时夹闭主要血管蒂，以确保仅由二级蒂供血时的血供。
步骤4 游离肌皮瓣：横断股薄肌的近端肌腱，为肌皮瓣提供最大长度，并结扎主要血管和神经蒂。
步骤5 植皮覆盖：将皮瓣缝合到位并用植皮覆盖。
步骤6 术后护理：膝关节固定两周；随后进行康复训练以恢复活动范围。
结果与术前/术后影像：我们治疗了3例全膝关节置换部位感染且植入物外露的患者。
适应证、禁忌证、陷阱与挑战。
