One-Stage Reconstruction of Extensor Mechanism with Free Composite Anterolateral Thigh Flap and Vascularized Fascia Lata after Malignant Tumor Resection of Knee

膝部惡性腫瘤切除後以大腿前外側皮膚及筋膜複合式自由皮瓣重建膝關節伸展功能之病例報告

倪宗聖(Tsung-Sheng Ni) ； 張世幸(Shih-Hsin Chang) ； 黃德揚(Ter-Yang Huang) ； 蕭弘道(Hung-Tao Hsiao) ； 董光義(Kwang-Yi Tung)

《台灣癌症醫學雜誌》 26卷1期 (2010/02) Pp. 37-42

https://doi.org/10.6323/JoCRP.2010.26.1.6

摘要

背景：膝關節軟組織合併伸展功能缺損的功能重建，對於整形外科醫生常常是一種挑戰。傳統上，需要多階段的手術來完成重建。但是多階段的手術既耗時又耗醫療費，結果也常常不是非常令人滿意。目標：這些病患不僅需要軟組織重建，並且需要重建膝關節的功能。使用大腿前外側皮膚及筋膜複合式自由皮瓣，來同時作軟組織及肌腱的重建。材料與方式：我們報告一例膝關節惡性腫瘤經廣泛切除後軟組織及伸展機能缺損，以大腿前外側皮膚及筋膜複合式自由皮瓣來做軟組織及髕骨肌腱的重建。結果：經過一年的追蹤，病患膝關節的伸展功能沒有明顯的缺損，膝關節的彎曲可達95度。病患可不用柺杖自行行走。結論：使用大腿前外側皮膚及筋膜複合式皮瓣，對同時重建肌腱及軟組織，得到非常良好的功能重建。

關鍵字

伸展機能重建 ； 大腿前外側自由皮瓣 ； 帶血管筋膜移植

並列摘要

Background: Combined loss of the extensor apparatus with overlying soft tissue at the level of the knee joint is a difficult challenge to the reconstructive surgeon. Traditionally, it can be achieved with staged operations. However, multiple-stage reconstructions are time-consuming and costly, and the results are usually not satisfactory.Objectives: These patients need not only soft-tissue coverage for the defects but also functional recovery of the knee joint. The composite free anterolateral thigh (ALT) flap can provide soft-tissue coverage and vascularized fascia lata for tendon reconstruction.Methods: We report on a patient with a composite skin and knee extensor mechanism defect after an ablative surgery for malignancy treated by an anterolateral thigh (ALT) flap incorporated with vascularized fascia lata for reconstruction of the patellar tendon defect.Results: One year after the operation, there was no extensor lag at the knee, with knee flexion of 95°. This patient is able to walk without support.Conclusions: This one-stage surgical procedure simultaneously provides excellent functional tendon reconstruction and adequate soft-tissue coverage.

並列關鍵字

extensor mechanism ； free anterolateral thigh flap ； vascularized fascia graft