摘要
目的对膝上外侧动脉穿支螺旋桨皮瓣进行解剖研究,并探讨其修复膝关节前外侧软组织缺损的手术方法及临床效果。方法 2019年9月至2021年9月,宁波市第一医院整形修复重建外科对4例8侧成人下肢冰鲜标本进行解剖,观测膝上外侧动脉穿支并记录穿支蒂长、穿支起始部外径及皮肤穿出点位置。临床应用膝上外侧动脉穿支螺旋桨皮瓣修复5例膝关节前外侧软组织缺损患者,男3例,女2例,年龄25~48岁,平均33.4岁;其中2例合并韧带损伤和(或)骨关节外露,软组织缺损面积4.0 cm×4.0 cm~8.0 cm×5.0 cm,切取膝上外侧动脉穿支螺旋桨皮瓣面积10.0 cm×5.0 cm~13.0 cm×6.0 cm,术前行微泡超声造影寻找膝上外侧动脉优势穿支血管并标记皮肤穿出点,术中使用CDU确认优势血管皮肤穿出点,根据膝前外侧软组织缺损的面积设计膝上外侧动脉穿支螺旋桨皮瓣,制备皮瓣并转移至缺损区。术后门诊随访,观察皮瓣的成活情况,并按照Bai-ly膝关节评分标准进行膝关节功能评定。结果解剖发现,膝上外侧动脉穿支蒂长(8.2±0.9)cm,起始部外径(1.1±0.2)mm。临床5例皮瓣全部成活,术后均获得随访,随访时间10~24个月,平均15.3个月,皮瓣术后2周Ⅰ期愈合,均未出现软组织感染、骨关节感染等并发症。末次随访外形无明显臃肿,皮瓣色泽、弹性同周围皮肤相近,膝关节功能评定:优4例,良1例,膝关节屈、伸范围100°~150°,患者对膝关节外观及功能满意。结论膝上外侧动脉穿支管径、蒂长理想,其螺旋桨皮瓣修复膝关节前外侧软组织缺损外观良好,膝关节功能恢复满意,是修复膝关节前外侧软组织缺损的良好方法。
Objective To study the anatomy of the perforator propeller flap of superior lateral genicular artery,and to explore a surgical method and clinical application in repair of the soft tissue defect of anterolateral knee with the flap.Methods From September 2019 to September 2021,8 knees of 4 chilled fresh specimen of adults were studied.The perforators of the superior lateral genicular artery were observed.The length,outer diameter of the perforators,and the locations of the skin perforation were recorded.The superior lateral genicular artery perforator propeller flaps were then applied clinically to 5 patients(3 males and 2 females)with soft tissue defects of anterolateral knee.Two of the patients had combined ligament injury and(or)bone joint exposure.The age of patients ranged from 25 to 48 years old,at 33.4 years old in average.The sizes of soft tissue defects ranged from 4.0 cm×4.0 cm to 8.0 cm×5.0 cm.The sizes of perforator propeller flaps of superior lateral genicular artery were 10.0 cm×5.0 cm to 13.0 cm×6.0 cm.The superior perforating vessels of the superior lateral genicular artery were found and marked at the points of skin perforation.Preoperative contrast-enhanced ultrasound were performed to confirm the dominant perforating vessels and had the skin perforating points marked.Intraoperative CDU were further performed to confirm the points of dominant perforating vessels.Perforator propeller flaps were designed depending on the size of the anterolateral soft tissue defect,and flaps were prepared and transferred to the defect sites.Postoperative follow-ups were conducted at outpatient clinic.The survival of the flap and knee function were observed according to the Bai-ly knee scoring.Results The anatomy showed that an average pedicle length of the superior lateral genicular artery perforator was(8.2±0.9)cm,with an average starting outer diameter at(1.1±0.2)mm.All 5 flaps survived during the follow-up that lasted for 10 to 24 months,with an average of 15.3 months.All flaps healed in 2 weeks after surg
作者
徐振华
叶朝辉
陈薇薇
郭明君
魏鹏
XU Zhenhua;YE Zhaohui;CHEN Weiwei;GUO Mingjun;WEI Peng(Department of Pediatric Orthopedics,Ningbo Women and Children's Hospital,Affiliated to Ningbo University School of Medicine,Ningbo,Zhejiang Province 315012,China;Department of Plastic Repair and Reconstructive Surgery,Ningbo First Hospital,Ningbo,Zhejiang Province 315010,China)
出处
《中华显微外科杂志》
CSCD
北大核心
2023年第1期89-94,共6页
Chinese Journal of Microsurgery
基金
宁波市公益类科技计划项目(202002N3182)
浙江省医药卫生科技项目(2019KY569)
浙江省自然科学基金(BY23H180015)。
关键词
膝上外侧动脉
穿支螺旋桨皮瓣
软组织缺损
膝关节
应用解剖
Superior lateral genicular artery
Perforator propeller flap
Soft tissue defect
Knee joint
Applied anatomy
