膝降动脉隐支皮瓣的解剖学特点及其修复老年患者膝前创面的效果

丁伟; 刘相坤; 程少文; 李磊; 赵飞龙; 鲍文秀; 池征璘

doi:10.3760/cma.j.cn501225-20250729-00332

膝降动脉隐支皮瓣的解剖学特点及其修复老年患者膝前创面的效果

doi: 10.3760/cma.j.cn501225-20250729-00332

1.
皖南医科大学弋矶山医院创面修复外科/整复重建外科,芜湖　241000
2.
海南医科大学第一附属医院,急救与创伤研究教育部重点实验室,海南省创伤与灾难救援研究重点实验室,创面修复科,海口　570102

基金项目:

国家自然科学基金地区科学基金项目 82260373

安徽省教育厅科学研究重大项目 2025AHGXZK20242

详细信息

通讯作者:
池征璘,Email：57699788@qq.com

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出版历程
- 收稿日期: 2025-07-29
- 网络出版日期: 2026-09-09

Anatomical characteristics of the saphenous branch flap with the descending genicular artery and its efficacy in anterior knee wound reconstruction in elderly patients

1.
Department of Wound Repair and Reconstructive Surgery, Yijishan Hospital, Wannan Medical College, Wuhu 241000, China
2.
Key Laboratory of Emergency and Trauma of Ministry of Education, Key Laboratory of Hainan Trauma and Disaster Rescue, Department of Wound Repair, the First Affiliated Hospital, Hainan Medical University, Haikou 570102, China

Funds:

National Natural Science Foundation of China Regional Science Foundation Project 82260373

Major Scientific Research Project of Anhui Provincial Department of Education 2025AHGXZK20242

More Information

Corresponding author: Chi Zhenglin, Email: 57699788@qq.com

摘要

摘要: 目的探讨膝降动脉隐支皮瓣的解剖学特点及其修复老年患者膝前创面的效果。方法该研究为有创观察研究和回顾性病例系列研究。2018年4—7月,对来自皖南医科大学临床解剖教研室的5具自愿捐献的成人（男4具、女1具,年龄52~71岁）尸体下肢标本进行解剖学研究。对5具尸体的各2侧下肢标本行精细解剖,观测并记录膝降动脉的起源、起源处血管外径和长度及起源处与股骨内上髁的垂直距离,膝降动脉隐支的起源、起源处血管外径和肌间段长度。2018年8月—2024年10月,皖南医科大学弋矶山医院收治19例符合入选标准的膝前创面老年患者,其中男12例、女7例,年龄60~78岁,清创后创面面积为5.0 cm×4.0 cm~15.0 cm×7.5 cm。均采用膝降动脉隐支皮瓣修复创面,皮瓣切取面积为6.0 cm×5.0 cm~16.0 cm×8.5 cm。将供区创面直接缝合。术后观察皮瓣成活情况、供受区创面愈合情况。术后随访皮瓣质地和外观、供受区瘢痕形成情况。末次随访时,测定皮瓣两点辨别觉距离并根据中华医学会手外科学会上肢部分功能评定试用标准对皮瓣两点辨别觉进行评级,采用国际膝关节文献委员会主观膝关节功能量表评估膝关节功能并评级。结果 10侧下肢标本中,膝降动脉均起源于股动脉,起源处血管外径为（2.00±0.30）mm,起源处血管长度为（0.8±0.3）cm,起源处与股骨内上髁的垂直距离为（12.5±0.8）cm。8侧下肢标本的膝降动脉隐支起源于膝降动脉,2侧下肢标本的膝降动脉隐支起源于股动脉；膝降动脉隐支起源处血管外径为（1.20±0.20）mm,肌间段长度为（10.0±0.8）cm。术后皮瓣均顺利成活,供受区创面均愈合良好。术后随访6~12个月显示,皮瓣质地、色泽、厚度与受区正常皮肤接近,供受区仅遗留线性瘢痕。末次随访时,皮瓣两点辨别觉评定为S4级者7例、S3⁺级者12例,膝关节功能评定为优者11例、良者6例、差者2例。结论膝降动脉及其隐支出现率高且解剖位置恒定,膝降动脉总支的血管蒂长度和外径很适合皮瓣切取和转移。采用膝降动脉隐支皮瓣修复膝前创面后供受区外观、皮瓣感觉及膝关节功能恢复良好,是老年患者膝前创面修复的适宜选择。
- 老年人 /
- 膝关节 /
- 创伤和损伤 /
- 解剖学 /
- 穿支皮瓣 /
- 膝降动脉 /
- 隐支
Abstract: Objective To investigate the anatomical characteristics of the saphenous branch flap with the descending genicular artery and its efficacy in repairing anterior knee wounds in elderly patients. Methods This study consisted of an invasive observational study and a retrospective case series study. From April to July 2018, the anatomical study was conducted on the lower limb specimens from 5 voluntarily donated adult cadavers (4 males and 1 female, aged 52-71 years) obtained from the Department of Clinical Anatomy of Wannan Medical University. Fine dissections were performed on both lower limbs of each of the 5 cadavers. The origin, external diameter at the origin, length, and vertical distance from the origin to the medial femoral epicondyle of the descending genicular artery, as well as the origin, external diameter at the origin, and intermuscular course length of its saphenous branch, were observed and recorded. From August 2018 to October 2024, 19 elderly patients (12 males and 7 females, aged 60-78 years) with anterior knee wounds meeting the inclusion criteria were treated at Yijishan Hospital of Wannan Medical University. The wound sizes after debridement ranged from 5.0 cm×4.0 cm to 15.0 cm×7.5 cm. All wounds were repaired using the saphenous branch flap with the descending genicular artery, with flap sizes ranging from 6.0 cm×5.0 cm to 16.0 cm×8.5 cm. All donor site wounds were directly sutured. Postoperative assessments included flap survival, wound healing in the donor and recipient sites, and follow-up evaluations of flap texture and appearance, scar formation in the donor and recipient sites. At the last follow-up, two-point discrimination distance of the flap was measured and graded according to the trial standards for evaluation of partial function of upper extremity by the Hand Surgery Society of Chinese Medical Association, and knee function was evaluated and graded using the International Knee Documentation Committee Subjective Short Form. Results In the 10 lower limb specimens, the descending genicular artery always originated from the femoral artery, with an external diameter of (2.00±0.30) mm at its origin, a length of (0.8±0.3) cm, and a vertical distance of (12.5±0.8) cm from its origin to the medial femoral epicondyle. The saphenous branch originated from the descending genicular artery in 8 lower limb specimens and from the femoral artery in 2 lower limb specimens. The saphenous branch had an external diameter of (1.20±0.20) mm at its origin and an intermuscular course length of (10.0±0.8) cm. All flaps survived uneventfully after surgery, and both donor and recipient sites healed well. During a follow-up period of 6 to 12 months, the flaps closely matched the recipient site in texture, color, and thickness, and only linear scars exhibited in the donor and recipient sites. At the last follow-up, the two-point discrimination was graded as S4 in 7 cases and S3⁺ in 12 cases; the knee function was rated as excellent in 11 cases, good in 6 cases, and poor in 2 cases. Conclusions The descending genicular artery and its saphenous branch have a high occurrence rate and a constant anatomical position, with vascular pedicle length and external diameter well-suited for flap harvesting and transfer. The application of the saphenous branch flap with the descending genicular artery for anterior knee wound repair can achieve satisfactory recovery of donor and recipient site appearance, flap sensation, and knee joint function, making it a suitable option for anterior knee wound repair in elderly patients.
- Aged /
- Knee joint /
- Wounds and injuries /
- Anatomy /
- Perforator flap /
- Descending genicular artery /
- Saphenous branch
丁伟：研究设计与实施、论文撰写与审定、资料采集、数据处理、经费支持；刘相坤、李磊：研究实施、资料采集、数据处理；程少文：研究指导、文章审阅与修改、理论指导；赵飞龙、鲍文秀：围手术期管理、资料采集；池征璘：研究指导、文章审阅与修改

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图 1 1具成人尸体标本的左下肢膝内侧血管解剖学观察结果

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图 2 膝降动脉隐支皮瓣的设计与切取。2A.皮瓣设计示意图；2B.在经乳胶灌注的1具成人尸体左下肢标本上,模拟皮瓣切取

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图 3 采用膝降动脉隐支皮瓣修复例1老年患者右膝前创面的效果。3A.术前右膝前创面；3B.于患侧设计膝降动脉隐支皮瓣；3C.术中切取皮瓣；3D.转移皮瓣修复创面后即刻；3E.术后随访8个月时,皮瓣和供区外观良好；3F.术后随访8个月时,右膝关节屈曲功能良好

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图 4 采用膝降动脉隐支皮瓣修复例2老年患者左膝前创面的效果。4A.术前左膝前创面；4B.于患侧设计膝降动脉隐支皮瓣；4C.术中切取皮瓣转移修复创面后即刻；4D.转移皮瓣修复创面后即刻；4E.术后随访9个月时,皮瓣和供区外观良好；4F.术后随访9个月时,左膝关节屈曲功能良好

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