精准皮瓣外科理念下逆行股前外侧皮瓣修复膝关节前方创面的临床效果

何晓清; 杨曦; 石岩; 段家章; 董凯旋; 徐月仙; 徐永清; 苏踊跃

doi:10.3760/cma.j.cn501225-20221020-00461

精准皮瓣外科理念下逆行股前外侧皮瓣修复膝关节前方创面的临床效果

doi: 10.3760/cma.j.cn501225-20221020-00461

1.
解放军联勤保障部队第九二〇医院骨科，昆明　　650032
2.
云南省第二人民医院急诊外科，昆明　　650021
3.
云南省第一人民医院骨科，昆明　　650034

基金项目:

云南省创伤骨科临床医学中心 ZX2019-10-01

云南省骨科与运动康复临床医学研究中心 202102AA310068

云南省科技厅科技计划项目 202101AY070001-298, 202201AY070001-288, 202201AY70001-292

联勤保障部队第九二〇医院院内科技计划 2019YGB05, 2020YGD08, 2020YGC02

详细信息

通讯作者:
苏踊跃，Email：drsuyy@qq.com

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出版历程
- 收稿日期: 2022-10-20

Clinical effects of retrograde anterolateral thigh flaps in repairing anterior knee joint wounds under the concept of precise flap surgery

1.
Department of Orthopedic Surgery, the 920th Hospital of Joint Logistic Support Force of PLA, Kunming 650032, China
2.
Department of Emergency Surgery, the Second People's Hospital of Yunnan Province, Kunming 650021, China
3.
Department of Orthopedic Surgery, the First People's Hospital of Yunnan Province, Kunming 650034, China

Funds:

Yunnan Provincial Clinical Orthopaedic Trauma Medical Center ZX2019-10-01

Yunnan Orthopedics and Sports Rehabilitation Clinical Medicine Research Center 202102AA310068

Science and Technology Planning Program of Yunnan Province Science and Technology Department 202101AY070001-298, 202201AY070001-288, 202201AY70001-292

In-hospital Science and Technology Program of the 920th Hospital of Joint Logistic Support Force of PLA 2019YGB05, 2020YGD08, 2020YGC02

More Information

Corresponding author: Su Yongyue, Email: drsuyy@qq.com

摘要

摘要: 目的介绍在精准皮瓣外科理念下用逆行股前外侧皮瓣修复膝关节前方创面的方法并探讨其临床效果。方法采用回顾性观察性研究方法。2014年8月—2022年3月，解放军联勤保障部队第九二〇医院在精准皮瓣外科理念的指导下，用逆行股前外侧皮瓣修复7例患者膝关节前方创面，患者中男6例、女1例，年龄36~66岁，清创后创面面积7 cm×5 cm~15 cm×11 cm。所有病例均行术前CT血管造影（CTA）检查，按照精准皮瓣外科方法评估皮瓣供、受区，选择最佳的皮瓣血管蒂、穿支和旋转点，皮瓣面积为10 cm×6 cm~20 cm×9 cm。将所有皮瓣供区直接缝合。观察术中探查情况与术前CTA情况是否一致。术后观察皮瓣成活情况及并发症发生情况。随访观察皮瓣色泽、外形、质地及并发症发生情况。末次随访时，采用中华医学会手外科学分会断指再植功能评定试用标准的血液循环评价指标评估皮瓣血液循环状态，采用特种外科医院膝关节评分系统评估膝关节功能。结果所有皮瓣术中探查情况与术前CTA情况完全吻合。6例患者术后皮瓣完全成活；1例患者皮瓣末端坏死，经换药后愈合。术后所有皮瓣过度充盈，1周后皮瓣色泽逐渐趋于正常。术后随访7~44个月，所有患者皮瓣色泽、外形、质地良好；1例患者胫骨近端出现局部骨髓炎。末次随访时，7例患者血液循环均为优；膝关节功能评分为69~91分，评定为优者3例、良者3例、中者1例。结论逆行股前外侧皮瓣变异大，应用精准皮瓣外科的方法能在术前精准了解变异情况，从而指导皮瓣设计和切取，实现膝关节前方创面的精准修复，且修复效果良好。
- 外科皮瓣 /
- 软组织损伤 /
- 膝关节 /
- 计算机体层摄影血管造影术 /
- 精准外科 /
- 创面修复
Abstract: Objective To introduce the methods of retrograde anterolateral thigh flaps in repairing anterior knee joint wounds under the concept of precise flap surgery and to explore the clinical effects. Methods A retrospective observational study was conducted. From August 2014 to March 2022, 7 patients with anterior knee joint wounds were treated with retrograde anterolateral thigh flap under the guidance of the concept of precise flap surgery in the 920 ^th Hospital of Joint Logistic Support Force of PLA. Among them, 6 were males and 1 was female, aged 36 to 66 years. The sizes of wounds were 7 cm×5 cm to 15 cm×11 cm after debridement. All the patients were performed with computed tomography angiography (CTA), the donor and recipient sites were evaluated according to the precise flap surgery method, and the optimal pedicle, perforator, and pivot of flaps were chosen. The flap sizes were 10 cm×6 cm to 20 cm×9 cm, and all the donor sites of flaps were sutured directly. The consistency of the intraoperative exploration with preoperative CTA was observed. The flap survival and occurrence of complications were observed after surgery. The color, appearance, texture, and occurrence of complications were followed up. At the last follow-up, the blood supply of flaps was evaluated using the blood circulation evaluation indicators of Chinese Medical Association Hand Surgery Branch's trial criteria for digital replantation function evaluation, and the function of knee joint was evaluated using knee joint scoring system of hospital for special surgery. Results The flap condition of the intraoperative exploration was completely consistent with that of preoperative CTA. The flaps survived completely after surgery in 6 patients, while necrosis at the edge of the flap occurred in 1 patient, which healed after dressing change. All the flaps were hyperperfused after surgery, and the color of the flaps gradually became normal after 1 week. Follow-up of 7 to 44 months showed that the color, appearance, and texture were well in all the patients, while local osteomyelitis at the proximal tibia occurred in 1 patient. At the last follow-up, all the 7 patients had excellent blood circulation; the function score of knee joint was 69 to 91, which was evaluated as excellent in 3 cases, good in 3 cases, and fair in 1 case. Conclusions The retrograde anterolateral thigh flap has large variations, and the application of precise flap surgery method can accurately understand the variations before surgery, guide the design and cutting of the flaps, thus achieving precise repair of anterior knee joint wounds, with good repair outcome.
- Surgical flaps /
- Soft tissue injuries /
- Knee joint /
- Computed tomography angiography /
- Precise surgery /
- Wound repair
何晓清：提出理念，手术操作，论文写作；杨曦、石岩：完善理念，手术操作；段家章、董凯旋：手术操作，资料收集；徐月仙、徐永清：手术操作；苏踊跃：课题设计，手术操作，经费支持

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1 术前CT血管造影（CTA）断层及三维重建确定逆行股前外侧皮瓣的血管蒂。1A.术前CTA显示旋股外侧动脉降支发出穿支（红色箭头）位置；1B.术前CTA显示旋股外侧动脉与股深动脉终末支吻合点（黄色箭头），即逆行股前外侧皮瓣的旋转点；1C.术前CTA显示创面（蓝色箭头）位置；1D.皮瓣穿支（红色箭头）、旋转点（黄色箭头）及创面（蓝色箭头）在旋股外侧动脉降支三维重建影像上的对应位置

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2 精准皮瓣外科理念下逆行股前外侧皮瓣修复患者右膝关节骨折脱位内固定术后严重感染创面。2A.清创后膝关节前方创面；2B.术前右腿CT血管造影三维重建影像；2C.术前精确设计皮瓣，标记血管蒂走行、穿支位置、皮瓣大小和旋转点；2D.术中切取逆行股前外侧皮瓣；2E.皮瓣覆盖创面并缝合后即刻；2F.术后11个月复查，皮瓣色泽及外形良好

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