膝上内侧自由式穿支螺旋桨皮瓣修复膝关节及其周围深度创面的临床效果

罗玉明; 刘梦栋; 杨琪瑛; 高晓文; 朱靓; 李军

doi:10.3760/cma.j.cn501225-20240609-00220

膝上内侧自由式穿支螺旋桨皮瓣修复膝关节及其周围深度创面的临床效果

doi: 10.3760/cma.j.cn501225-20240609-00220

1.
空军军医大学第一附属医院烧伤与皮肤外科,西安　　710032
2.
空军军医大学预防医学系卫生事业管理和医学教育教研室,西安　　710032

基金项目:

国家自然科学基金面上项目 81971834

详细信息

通讯作者:
李军,Email：xjburns@fmmu.edu.cn

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出版历程
- 收稿日期: 2024-06-09

Clinical effect of above-knee medial free-style perforator propeller flap in repairing deep wounds in and around the knee joint

1.
Department of Burns and Cutaneous Surgery, the First Affiliated Hospital of Air Force Medical University, Xi'an 710032, China
2.
Department of Health Service Management and Medical Education, School of Military Preventive Medicine, Air Force Medical University, Xi'an 710032, China

Funds:

General Program of National Natural Science Foundation of China 81971834

More Information

Corresponding author: Li Jun, Email: xjburns@fmmu.edu.cn

摘要

摘要: 目的探讨采用膝上内侧自由式穿支螺旋桨皮瓣修复膝关节及其周围深度创面的临床效果。方法该研究为回顾性观察性研究。2020年12月—2023年10月,空军军医大学第一附属医院烧伤与皮肤外科收治13例符合入选标准的膝关节及其周围深度烧创伤创面患者,其中男9例、女4例,年龄16~70岁。清创后皮肤软组织缺损面积为5.0 cm×4.0 cm~9.0 cm×7.0 cm。以穿支血管为蒂在膝上内侧设计并切取自由式穿支螺旋桨皮瓣（面积为6.0 cm×4.0 cm~15.0 cm×7.0 cm）,其中大桨用于修复膝关节及其周围创面,小桨则辅助供区创面闭合。术后,观察皮瓣成活情况,供受区创面愈合情况及有无感染、积液、坏死等并发症。随访时,观察皮瓣外形、色泽、质地等情况,观察受区创面愈合情况、瘢痕挛缩及膝关节活动情况,记录供区瘢痕情况、感觉功能恢复情况和有无相关并发症。结果术后,13例患者皮瓣均成活。1例患者皮瓣边缘出现感染,经适当引流、换药等处理后愈合,供区创面愈合良好；其余12例患者供受区创面均顺利愈合,无并发症发生。随访5~24个月显示,13例患者皮瓣外形自然、色泽正常、触感柔软且富有弹性；受区创面愈合良好,无瘢痕挛缩畸形,膝关节活动自如；大腿内侧供区遗留轻微线状瘢痕,感觉功能正常,未出现麻木现象。结论采用膝上内侧自由式穿支螺旋桨皮瓣修复膝关节及其周围深度创面时,皮瓣切取简便且创伤小,术后供受区外形和功能好。
- 烧伤 /
- 创伤和损伤 /
- 外科皮瓣 /
- 膝关节 /
- 自由式穿支皮瓣 /
- 螺旋桨皮瓣 /
- 创面修复
Abstract: Objective To explore the clinical effect of applying above-knee medial free-style perforator propeller flap in repairing deep wounds in and around the knee joint. Methods This study was a retrospective observational study. From December 2020 to October 2023, the Department of Burns and Cutaneous Surgery of the First Affiliated Hospital of Air Force Medical University admitted 13 patients who met the inclusion criteria and had deep burn wounds in and around the knee joints, including 9 males and 4 females, aged 16-70 years. After debridement, the sizes of skin and soft tissue defects ranged from 5.0 cm×4.0 cm to 9.0 cm×7.0 cm. A free-style perforator propeller flap was designed and harvested from the medial supragenicular region, using a perforator vessel as the pedicle. The size of the flap ranged from 6.0 cm×4.0 cm to 15.0 cm×7.0 cm. The larger paddle of the flap was used to repair the wound in and around the knee joint, while the smaller paddle assisted in closing the donor site wound. After surgery, the survival status of the flap, wound healing at the donor and recipient sites, and complications such as infection, effusion, and necrosis were observed. During the follow-up, the appearance, color, and texture of the flap as well as the wound healing, scar contracture, and knee joint mobility at the recipient site were observed, and the scar condition, sensory recovery, and complications at the donor site were recorded. Results Postoperatively, all 13 patients achieved successful flap survival. In one case, infection occurred at the edge of the flap but healed after appropriate treatment including drainage and dressing changes, and the donor site wound healed well; the remaining 12 patients showed uneventful healing at both donor and recipient sites without complications. During follow-up of 5 to 24 months, all 13 patients exhibited natural appearance, normal skin color, soft texture, and good elasticity. The recipient site wounds healed well without scar contracture or deformity, with full range of motion in the knee joint. A mild linear scar remained at the donor site on the inner thigh, with normal sensory function and no numbness. Conclusions The above-knee medial free-style perforator propeller flap demonstrates simple harvest with minimal trauma for repairing deep wounds in and around the knee joint, providing satisfactory aesthetic and functional outcomes at both donor and recipient sites.
- Burns /
- Wounds and injuries /
- Surgical flaps /
- Knee joint /
- Free-style perforator flap /
- Propeller flap /
- Wound repair
罗玉明：论文撰写、数据整理、手术实施；刘梦栋、高晓文：手术实施、资料采集、论文修改；杨琪瑛、朱靓：研究设计、数据采集、论文修改；李军：手术实施、研究指导、论文审阅及指导、经费支持

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图 1 左侧膝上内侧自由式穿支螺旋桨皮瓣修复例1患者左侧膝关节及其周围皮肤软组织缺损合并髌骨外露的效果。1A.入院时,左侧膝关节及其周围皮肤软组织缺损合并髌骨外露；1B.清创后,于左侧大腿设计膝上内侧自由式穿支螺旋桨皮瓣；1C.术中,切取皮瓣及显露穿支（黄色箭头所示）；1D.术中,将皮瓣向膝关节创面行螺旋桨式转移；1E.将皮瓣大桨完全覆盖创面,在皮瓣小桨辅助下直接缝合供区创面即刻；1F.术后12个月随访时,皮瓣外观良好

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图 2 双侧大腿膝上内侧自由式穿支螺旋桨皮瓣修复例2患者双侧膝关节及其周围皮肤软组织缺损的效果。2A.入院时,双侧膝关节及其周围皮肤软组织缺损；2B.术中,于双侧大腿内侧设计皮瓣；2C、2D.分别为术中切取右侧、左侧膝上内侧自由式穿支螺旋桨皮瓣及显露穿支（黄色箭头所示）；2E.将皮瓣大桨覆盖创面,在皮瓣小桨辅助下直接缝合供区创面即刻；2F.术后6个月随访时,皮瓣外观良好,供区仅遗留线状瘢痕

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