腓动脉及穿支血管蒂皮瓣移位修复

中国修复重建外科杂志2009年3月第23卷第3期·303·

• 论 著 •腓动脉及穿支血管蒂皮瓣移位修复

膝关节周围软组织缺损

阮洪江蔡培华范存义柴益民刘生和

【摘 要】目的探讨应用腓动脉及穿支血管蒂皮瓣顺行移位修复膝关节软组织缺损的手术方法和临床效果。 方法2007年10月－2008年1月，收治3例车祸致膝关节周围软组织缺损患者。男2例，女1例；年龄分别为18、31、42岁。1例骨盆及股骨骨折伴腘窝部皮肤软组织缺损，骨折切开复位内固定术并膝关节清创术后2周；1例因胫

骨平台骨折切开复位内固定术后皮肤坏死3周；1例胫骨平台开放骨折伴内侧髁部皮肤软组织缺损，清创外固定术后3周。

皮肤软组织缺损大小分别为16 cm × 9 cm、11 cm × 6 cm及14 cm × 7 cm。术中分离显露包含于皮瓣内的1～2支腓动脉

穿支，于腓动脉穿支发出，远端结扎切断腓动脉及静脉，向近端游离腓血管至腓骨头下7～9 cm，以此为旋转点，连同皮瓣

向近端移位修复缺损。切取皮瓣大小分别为18 cm × 10 cm、12 cm × 7 cm及15 cm × 8 cm，血管蒂长10～17 cm。供区

创口两端直接缝合，中部残留创面以游离皮片移植修复。 结果术后3例皮瓣全部成活。供区与创面均Ⅰ期愈合，植

皮均成活。3例均获随访，随访时间分别为6、8及11个月。皮瓣色泽、质地良好，外形满意。根据改良HSS膝关节评分

标准，膝关节功能均为优。 结论腓动脉及穿支血管蒂营养皮瓣血管蒂长，蒂部细小易移位且不易受压，血供可靠，切

取范围大，外形美观，用于膝关节皮肤软组织缺损的修复临床效果满意。

【关键词】腓动脉穿支皮瓣膝部软组织缺损修复

中图分类号： R622.1 R658.3 文献标志码：A

ANTEGRADE EXTENDED PERONEAL ARTERY PERFORATOR FLAP FOR KNEE RECONSTRUCTION/RUAN Hongjiang, CAI Peihua, FAN Cunyi, CHAI Yimin, LIU Shenghe. Department of Orthopaedics, the Sixth People’s Hospital, Shanghai Jiao Tong University, Shanghai, 200233, P.R.China. Corresponding author: CAI Peihua, E-mail: laocai501@ 【Abstract】Objective To investigate the operative technique and clinical results of repairing the soft tissue defects

of knee with antegrade extended peroneal artery perforator flap.Methods From October2007to January2008,3patients(2 men and1woman)with the soft tissue defects of knee were treated,with the ages of18,31and42years,respectively.The first case sustained femur and pelvis fractures and soft tissue defect over his right popliteal fossa,which were treated with open reduction and internal fixation(ORIF)and debridement of knee joint2weeks ago.The second case was necrosis of skin3weeks after ORIF

for fracture of tibial plateau.The third case suffered from open fracture of tibial plateau and soft tissue defect,which were treated with external fixation and debridement3weeks ago.The defect sizes were16cm × 9cm,11cm × 6cm and14cm × 7cm.The flap was raised by dividing the peroneal artery and veins distally and elevating them proximally,which covered for the defects of knee. The flaps were designed with the size of18cm×10cm,12cm×7cm and15cm×8cm.The pure vascular pedicle of the flap was

10cm to17cm in length,including the peroneal vessels and one or two perforator branches.The donor site is covered by a split thickness skin graft.Results All flaps survived after surgery.The donor sites healed by first intention and the skin grafts survived. After following up for6,8and11months,the appearance and function of the flaps were all satisfactory.Based on the modified HSS knee performance system,post-operative knee functional outcomes of three patients were excellent. Conclusion The antegrade extended peroneal artery perforator flap supplied by a pure vascular pedicle can be a good alternative for reconstruction of knee.The flap,with a long and thin pure vascular pedicle,could provide good texture and contour matching the recipient area.

【Key words】Peroneal artery perforator flap Knee Soft tissue defect Repair

膝关节作为主要的负重和运动关节，前后活动度较大，对其周围软组织柔韧性要求较高，所以对膝关节周围软组织损伤的修复应避免瘢痕组织形成，最大程

作者单位：上海交通大学附属第六人民医院骨科（上海，200233）通讯作者：蔡培华，副主任医师，研究方向：修复重建外科、显微外科，E-mail: laocai501@ 度挽救膝关节的屈伸功能。近年，以腓动脉穿支为蒂的筋膜皮瓣或伴皮神经营养的筋膜皮瓣得到广泛研究和应用[1-5]。在此基础上，我们改良腓动脉穿支皮瓣，延长腓动脉穿支蒂至腓血管主干，不仅适用于足踝部软组织缺损，还可修复膝关节周围软组织缺损。2007年10月－2008年1月，我们应用该皮瓣顺行移位修