Markovich G D, Dorr L D, Klein N E, McPherson E J, Vince K G
USC Center for Arthritis, Los Angeles, USA.
Clin Orthop Relat Res. 1995 Dec(321):122-30.
The results of 12 patients who had been treated with muscle flap coverage for compromised soft tissues associated with total knee arthroplasty were studied. Five latissimus dorsi free flaps, 6 medial gastrocnemius rotational flaps, and 2 rectus abdominis free flaps were done in 12 knees. The authors used and classified 3 types of muscle flaps: (1) prophylactic soft tissue coverage, done before definitive reconstruction; (2) treating muscle flap for infected prostheses with deficient soft tissue coverage; and (3) salvage muscle flap for wound dehiscence or necrosis in the immediate postoperative period. These patients were observed for an average of 4.1 years (range, 1-8 years). The wound was revascularized successfully in 100% of the knees. The prosthesis was preserved in 83% of the knees. Recurrent infection occurred in 3 patients. Treating muscle flaps are least likely to result in an overall successful reconstruction because these flaps are used in knees with chronic infection. Prophylactic flaps and salvage muscle flaps provide the soft tissue coverage necessary to allow successful reconstruction in the appropriate circumstances.
对12例因全膝关节置换术相关软组织受损而接受肌瓣覆盖治疗的患者的结果进行了研究。在12个膝关节中进行了5例背阔肌游离瓣、6例腓肠肌内侧旋转瓣和2例腹直肌游离瓣手术。作者使用并分类了3种肌瓣类型：（1）预防性软组织覆盖，在确定性重建前进行；（2）用于软组织覆盖不足的感染假体的治疗性肌瓣；（3）术后即刻用于伤口裂开或坏死的挽救性肌瓣。这些患者平均观察了4.1年（范围1 - 8年）。100%的膝关节伤口成功再血管化。83%的膝关节假体得以保留。3例患者发生复发性感染。治疗性肌瓣导致整体重建成功的可能性最小，因为这些肌瓣用于慢性感染的膝关节。预防性肌瓣和挽救性肌瓣提供了在适当情况下成功重建所需的软组织覆盖。
