Nahabedian M Y, Orlando J C, Delanois R E, Mont M A, Hungerford D S
Division of Plastic Surgery, Johns Hopkins University, Baltimore, MD, USA.
Clin Orthop Relat Res. 1998 Nov(356):119-24. doi: 10.1097/00003086-199811000-00017.
The management options for complex soft tissue defects about the knee are varied. Limb threatening conditions such as exposure of joint prosthesis or bone requires stable coverage to avoid amputation. A study was conducted to review the authors' management protocol and experience with complex defects about the knee. A retrospective analysis from 1986 to 1996 of 35 patients with complex defects about the knee was performed. Treatment options were based on the nature, size, location, and depth of the wound. A specific management protocol was applied for each patient. Treatments included local wound care, debridement and skin graft, fasciocutaneous flap, pedicled muscle flap, and free muscle transfer. Postoperatively, patients were evaluated using Knee Society objective and functional scores and other instruments to measure outcome. Successful salvage of the lower extremity was obtained in 34 (97%) patients. Salvage of the total knee prosthesis was obtained in 24 of 29 (83%) patients. Secondary plastic surgery procedures were necessary in eight (23%) patients. Secondary orthopaedic procedures were necessary in five (15%) patients. No patient required an amputation.
膝关节周围复杂软组织缺损的处理方法多种多样。诸如关节假体或骨质外露等危及肢体的情况需要稳定的覆盖以避免截肢。开展了一项研究以回顾作者对于膝关节周围复杂缺损的处理方案及经验。对1986年至1996年间35例膝关节周围复杂缺损患者进行了回顾性分析。治疗方案依据伤口的性质、大小、位置及深度而定。为每位患者应用了特定的处理方案。治疗方法包括局部伤口护理、清创及植皮、筋膜皮瓣、带蒂肌瓣及游离肌转移。术后，使用膝关节协会客观及功能评分以及其他工具对患者进行评估以衡量结果。34例（97%）患者成功挽救了下肢。29例患者中有24例（83%）成功挽救了全膝关节假体。8例（23%）患者需要二期整形手术。5例（15%）患者需要二期骨科手术。无患者需要截肢。
