Reconstruction of Small to Medium-Sized Soft Tissue Defects Around The Knee or Proximal Third of The Lower Leg with The Adipofascial Flap Based on The Superficial Lateral Sural Artery-4 Case Reports and Literature Review

使用以外側淺腓腸動脈為血管莖的脂肪筋膜皮瓣重建膝關節附近或近端脛前的軟組織缺損

洪章桂(Chang-Kuei Hong) ； 黃國峯(Kuo-Feng Huang) ； 林聿山(Yu-San Lin)

《臺灣整形外科醫學會雜誌》 24卷4期 (2015/12) Pp. 353-362

摘要

背景：重建膝關節周圍與脛前的軟組織缺損時常很困難。穩定的骨骼與良好的軟組織覆蓋提供成功的結果。目的及目標：我們提出四個臨床案例，使用外側淺腓腸動脈皮瓣來重建膝關節與脛前的軟組織缺損。材料及方法：四個臨床案例，包含三位男性與一位女性，平均年齡為47歲(25-79)，平均追蹤時間為7.7個月(3-12)。其中三個案例病因是下肢創傷，另一位是因為膝關節置換術後的化膿性關節炎。手術方式是使用外側淺腓腸動脈皮瓣，以脂肪筋膜皮瓣方式設計，來覆蓋膝關節與脛前的軟組織缺損。皮瓣和其餘外露部分以裂層皮膚植體覆蓋。取皮瓣處直接初級縫合。結果：所有皮瓣完全存活。其中一位病人出現術後血腫情況，清除血塊之後傷口癒合。三位病人取皮瓣處癒合良好，但有一位出現部分壞死情形，經過換藥傷口癒合，所有病人患肢足部外背側有感覺異常的情形，但在追蹤期間他們適應良好。結論：以外側淺腓腸動脈皮瓣重建下肢膝關節與脛前的軟組織缺損是一個有用的方式，這是一種簡單且可靠的手術。

並列摘要

Background: Reconstruction of soft tissue defects around the knee and tibia is always difficult. Adequate soft tissue coverage after bony stabilization is of the utmost importance for a successful outcome.Aim and Objectives: We describe 4 cases in which the superficial lateral sural artery flap was used for coverage over knee or tibia. Materials and Methods: The case reports consist of 4 patients, 3 men and 1 woman with an average age 47 years (25-79) and with an median follow-up time of 7.7 months (3-12). In three of the cases, aetiology was a lower limb injury caused by trauma. The last one was caused by septic arthritis after total knee arthroplasty. The technique is based on the use of the superficial lateral sural artery flap. The flap was designed as adipofacial flap fashion and transposed to cover the defect around the knee or tibia. The raw surface of the transposition flap was resurfaced with split-thickness skin graft. Donor site was allowed to be closed primarily. Results: All flaps survived. A postoperative hematoma occurred in one case, which is healed with evacuation. The donor site healed uneventfully in three cases. Exception was that one had minimal necrosis of donor site but it healed after wound care. Sensory loss of the dorsolateral aspect of the foot occurred, but they tolerate it well during the follow-up period in all cases. Conclusions: The superficial lateral sural artery flap is useful for reconstruction of soft tissue defects around the knee and on the proximal third and middle third of the lower leg. It is a relatively easy and reliable procedure.

並列關鍵字

soft tissue defect ； adipofascial flap ； superficial lateral sural artery