Free Anterolateral Thigh Flap with Vascularized Fascia Lata for Patellar Tendon and Knee Joint Soft Tissue Defect Reconstruction in Child-A Case Report

股前外側及闊筋膜張肌游離皮瓣重建兒童髕骨韌帶及膝軟組織缺損－病例報告

鐘一傑(Yi-Chien Chung) ； 劉致和(Chih-Ho Liu) ； 吳瑞星(Simon Jui-Hsing Wu) ； 鄧修國(Hsiu-Gwo Teng) ； 黃繼增(Chi-Tseng Huang)

《臺灣整形外科醫學會雜誌》 20卷1期 (2011/03) Pp. 60-66

https://doi.org/10.7096/TJTSPS.201103.0060

摘要

背景：
同時重建膝關節伸展機轉及廣泛的軟組織缺損是項艱鉅的任務，尤其是在兒童。考慮到孩童的生長及發育，使用自體組織來重建應是首選。
目的及目標：
我們提出一兒童因意外造成髕骨韌帶完全喪失及廣泛軟組織缺損，使用股前外側皮瓣合併闊筋膜張肌於單次手術中完成重建的病例報告。術後追蹤二年並進行功能評估。
材料及方法：
一位六歲男童因嚴重撕脫性傷害導致右側髕骨韌帶完全喪失及廣泛的軟組織缺損。在一連串的清創手術及負壓吸引傷口閉合輔助器的使用後，傷口得到了良好的肉芽組織增生。我們使用了對側的股前外側皮瓣併闊筋膜張肌游離皮瓣來進行重建。血管吻合後將闊筋膜張肌捲折並固定至股直肌及脛骨上以重建髕骨韌帶。接著軟組織缺損處由股前外側皮瓣覆蓋。供皮瓣區則以皮膚移植覆蓋。
結果：
術後恢復過程順利。二年的追蹤發現，膝部主動關節活動度達到了120度。男童重獲了正常的日常活動能力。
結論：
一次性手術來重建膝關節伸展機轉合併廣泛的軟組織缺損是值得努力的，因爲病人較少痛苦，較少住院天數並可較早期進行復健活動。股前外側併闊筋膜張肌皮瓣是個好的選擇，因可同時重建強健肌腱組織及大面積的軟組織覆蓋。然而在兒童可能需要較豐富的顯微手術經驗來進行管徑較小的血管吻合。

並列摘要

Background:
Simultaneous reconstruction of extensor mechanism and extensive soft tissue defect of the knee joint is a difficult task, especially in children. In consideration of child's growth and development, autologous tissue should be the method of choice for reconstruction.
Aim and Objectives:
We present a 6-year-old boy with total patellar tendon loss and extensive soft tissue defect reconstructed in a single-stage procedure with a composite anterolateral thigh (ALT) flap with vascularized fascia lata. Functional outcome was assessed at 2-year follow-up.
Materials and Methods:
A 6-year-old boy sustained severe degloving injury with total patellar tendon loss and extensive soft tissue defect. After serial debridement and vaccum-assisted wound closure (VAC) application for 3 weeks, good granulation was achieved. The contralateral ALT flap with vascularized fascia lata was raised for single-stage reconstruction. After vascular anastomosis was done, the fascia lata was rolled and fixed to rectus femoris muscle and the tibia for patellar tendon reconstruction. The ALT flap was then inset for soft tissue defect coverage. Donor site was closed with split thickness skin graft.
Results:
The post-operative course was uneventful. At 2-year follow-up, active range of motion is 120° (extension deficiency of 10° and flexion 130°). The patient regained abilities of normal daily activities.
Conclusion:
Single-stage reconstruction of knee extensor mechanism and soft tissue defect is worthwhile because of less patient suffering, shorter hospital stay and early mobilization. Autologous tissue should be the first choice for reconstruction in children. A composite ALT flap with vascularized fascia lata is a good choice for simultaneous tendon reconstruction and extensive soft tissue defect coverage. However, this procedure may need experienced microsurgical technuque for smaller caliber vascular anastomosis in children.

並列關鍵字

patellar tendon defect ； free flap ； anterolateral thigh flap