Medial Sural Artery Perforator (MSAP) Island Pedicle Flap for Medial Side of Knee Resurfacing under Epidural Anesthesia

在硬脊膜外腔麻醉下利用腓腸內側動脈穿支島狀帶莖皮瓣修復內側蓋軟組織缺損

張智豪(Chih-Hau Chang) ； 吳昇樺(Sheng-Hua Wu) ； 王文禾(Wen-Her Wang) ； 張高評(Kao-Ping Chang) ； 黃書鴻(Shu-Hung Huang) ； 賴春生(Chung-Sheng Lai) ； 林幸道(Sin-Daw Lin)

《中華民國整形外科醫學會雜誌》 18卷3期 (2009/09) Pp. 278-282

https://doi.org/10.7096/JPSA.200909.0278

摘要

背景：
膝蓋區域軟組織缺損的重建，文獻上報導過很多重建的方法，如病患疾病無法承受全身麻醉，可以考慮用局部皮辦重建配合硬脊膜外腔麻醉。
目的及目標：
硬脊膜外腔麻醉，可以降低急性肺部疾患的併發症，此外亦降低交感神經作用，增加周邊血流，並且持續由硬脊膜外腔給藥以減少術後疼痛。
材料及方法：
這位55歲男性為慢性阻塞性肺病，因外傷造成內側膝蓋軟組織缺損及合併氣血胸，由於患者不適合全身麻醉，我們利用腓腸內側動脈穿支島狀帶莖皮瓣配合硬脊膜外腔麻醉修復內側膝蓋軟組織缺損。
結果：
該個案在術後4個月的追蹤，外觀及厚度和膝部非常相似。
結論：
如病患疾病不適合作全身麻醉，此較薄的皮瓣配合硬脊膜外腔麻醉是利用局部皮辦重建中另一個好選擇。

並列摘要

Background:
Numerous techniques were reported for knee soft tissue defect reconstruction. Regional flap with epidural anesthesia could be considered if patient's underlying disease could not bear general anesthesia.
Aim and Objectives:
Epidural anesthesia instead of general anesthesia reduced high pulmonary morbidity in patients with pulmonary disease. Besides, epidural anesthesia can attenuate the surgical stress response, increase lower extremity blood flow associated with sympathectomy, and improve pain control.
Materials and Methods:
This 55 year old male has chronic obstruction pulmonary disease (COPD) with the problem of traumatic hemopneumothorax and soft tissue defect over medial side of left knee. Defect was resurfacing by medial sural artery perforator (MSAP) island pedicle flap under epidural anesthesia.
Results:
The MSAP island pedicle flap provides durable skin and thin soft-tissue coverage with good aesthetic result in four months follow up.
Conclusion:
The MSAP island pedicle flap could be an alternative choice in regional reconstruction, especially when patient's condition is not suitable for general anesthesia.

並列關鍵字

MSAP flap ； small size flap ； knee resurfacing