腓肠内侧动脉穿支蒂皮瓣修复膝和小腿上1/3软组织缺损

目的 报道应用腓肠内侧动脉穿支带蒂皮瓣修复膝和小腿上1/3软组织缺损的临床应用效果. 方法 应用腓肠内侧动脉穿支带蒂皮瓣修复膝和小腿上1/3软组织缺损16例.其中,髌前4例,前外侧2例,前内侧l例;小腿上1/3 9例.供区均选用同侧小腿.结果 手术后经过顺利,1例术后发生表浅感染,经更换敷料逐渐愈合,皮瓣全部成活.随访3.0个月至3.5年,平均1.7年.供区愈合良好,未见明显的供区功能障碍.受区皮瓣质地、厚薄及颜色均较好,功能恢复较好,取得了较满意的效果. 结论 腓肠内侧动脉穿支带蒂皮瓣以腓肠内侧动脉的肌皮穿支为血供,具有血供丰富、血管解剖恒定、血管蒂长以及皮瓣较薄的优点.带蒂移植适宜修复膝和小腿上1/3软组织缺损.     

腓动脉穿支跨区供血的腓肠神经营养血管逆行岛状皮瓣的解剖和临床应用

目的　观察小腿皮肤腓浅动脉与腓动脉穿支之间的吻合联系 ,设计以腓动脉穿支为蒂的岛状皮瓣。方法　 10具新鲜尸体 2 0侧肢体血管灌注氧化铅—明胶混合液 ,通过X线片显示小腿皮肤内的血管结构和血管之间的吻合。在此基础上应用了跨区供血的腓动脉穿支蒂逆行岛状皮瓣 2 6例。结果　解剖研究表明小腿腓肠神经营养血管主要来自腓浅动脉。在外踝后上方 4～ 7cm处腓动脉穿支与腓浅动脉或动脉网形成广泛吻合。以腓动脉穿支为蒂设计包含腓肠神经及其伴行的腓浅动脉和小隐静脉的返流岛状皮瓣 2 6例 ,皮瓣全部成活。结论　跨区供血的腓动脉穿支为蒂的岛状皮瓣 ,为修复小腿远端及足跟部软组织缺损提供了一种简单有效的方法。     

腓肠内侧动脉穿支皮瓣修复小腿中上段软组织缺损

目的 探讨应用腓肠内侧动脉穿支血管皮瓣带蒂转移修复小腿中上段皮肤软组织缺损的临床效果. 方法 2006年5月至2012年8月,对小腿中上段皮肤软组织缺损患者26例,创面面积为5 cm×3 cm～12cm×8cm.均应用同侧腓肠内侧动脉穿支血管皮瓣带蒂转移修复.皮瓣前内界为胫骨的内后缘,后外侧界为小腿后正中纵轴线,以腘皱褶中点至内踝中点连线为轴设计皮瓣,皮瓣面积为6 cm×4 cm～13 cm×9 cm. 结果 术后26例皮瓣全部成活.术后随访6～18个月,皮瓣质地柔软,富有弹性,不臃肿,供区无明显功能障碍,行走时步态基本正常. 结论 应用腓肠内侧动脉穿支皮瓣带蒂转移修复小腿中上段皮肤软组织缺损临床效果佳,该皮瓣血供丰富,血管解剖恒定,皮瓣质地良好,供区无明显功能障碍,故不失为修复小腿中上段皮肤软组织缺损的一种较好的选择.     

小腿穿支血管筋膜蒂皮瓣修复小儿足踝部软组织缺损

目的探讨小腿穿支血管筋膜蒂皮瓣修复小儿足踝部软组织缺损的临床疗效。方法 2012年5月-2015年1月,采用小腿穿支血管筋膜蒂皮瓣修复小儿足踝部软组织缺损12例。足踝部软组织缺损面积3.5 cm×5.0 cm～7.0 cm×15.0 cm,均伴有不同程度的肌腱或骨骼外露。带胫后动脉穿支的小腿内侧筋膜蒂皮瓣7例,带腓动脉外踝后上穿支的筋膜蒂皮瓣4例,带胫后动脉穿支的小腿内侧筋膜蒂皮瓣及带腓动脉外踝后上穿支的筋膜蒂皮瓣1例。结果术后12例皮瓣均成活,其中2例皮瓣皮缘远端少许坏死,经换药后愈合;12例获随访,随访时间3～18个月,平均8.9个月;皮瓣血运良好,无臃肿,外形满意,供区愈合良好;患肢功能良好。结论小腿穿支血管筋膜蒂皮瓣修复小儿足踝部软组织缺损操作简单,疗效可靠,是修复小儿足踝部软组织缺损理想的治疗方法之一。     

腓肠内侧动脉为蒂双叶肌皮瓣移植术

目的总结腓肠内侧动脉为蒂的双叶肌皮瓣移植术的临床应用结果。方法用腓肠内侧动脉为蒂的双叶肌皮瓣移植修复8例小腿近侧2/3胫前区软组织缺损(小腿上1/3有5例,中1/3有3例)。供区行一期中厚网孔状游离植皮修复。结果 8例患者经腓肠内侧动脉为蒂的双叶肌皮瓣游离移植修复的总体疗效较满意。供区游离植皮和双叶肌皮瓣全部成活。1例术后发生受区小的皮缘表浅感染,经伤口换药逐渐愈合。术后随访14个月至3年(平均2.2年月),供区愈合良好,未见明显的供区功能障碍;受区皮瓣质地、厚薄及颜色均较好,肢体功能恢复良好。结论该带蒂双叶肌皮瓣以腓肠内侧动脉为血供,具有血供丰富、血管解剖恒定、血管蒂长、肌瓣较薄等优点,适宜于修复小腿近侧2/3软组织缺损。     

结扎腓动脉穿支的外踝上岛状皮瓣修复足背部软组织缺损

目的 报道应用结扎腓动脉穿支的外踝上逆行岛状皮瓣修复足背软组织缺损的临床效果. 方法 在小腿外侧设计结扎腓动脉穿支的以腓动脉终末穿支降支为血管蒂的外踝上逆行岛状皮瓣对足背软组织缺损进行修复7例,皮瓣面积15 cm×9 cm～7 cm×3 cm.结果 术后皮瓣全部成活,创面均一期愈合.经3～12月随访皮瓣外形、色泽、质地满意.踝关节活动良好. 结论 通过结扎腓动脉外踝上穿支利用该穿支降支在足背部丰富的血管吻合网提供皮瓣的血运,增加了血管蒂的旋转半径,方法 简便、安全,为修复足背尤其是前足背部软组织缺损提供了一种可取的方法 .     

腓肠内侧动脉带蒂肌瓣的临床应用与改进

目的总结改进的腓肠内侧动脉带蒂肌瓣的临床应用结果。方法用此方法修复18例胫前区和膝关节周围软组织缺损。其中，胫骨上1／3软组织缺损6例，中1／3缺损5例，膝关节区7例。肌瓣表面行一期中厚网孔状游离植皮，供区直接缝合。结果肌瓣和其上植皮全部成活，受区外形较好，没有发现明显的供区功能障碍，取得了较满意的效果。2例术后发生表浅感染，经换药后愈合。结论该肌瓣以腓肠内侧动脉为血供，具有血供丰富、血管解剖恒定、血管蒂长以及肌瓣较薄等优点，带蒂移植适宜修复小腿上2／3和膝关节区软组织缺损。     

腓肠内侧动脉穿支皮瓣在小腿逆行岛状皮瓣供区修复中的应用

目的探讨腓肠内侧动脉穿支皮瓣在小腿逆行岛状皮瓣供区修复中的临床应用。方法 2015年5月-2018年6月采用腓肠内侧动脉穿支皮瓣修复小腿逆行岛状皮瓣供区8例,并观察其疗效。结果术后8例16个皮瓣均成活,随访3～15个月,皮瓣质地柔软,富有弹性,不臃肿,供区无明显功能障碍,行走时步态基本正常。结论腓肠内侧动脉穿支皮瓣接力修复小腿逆行岛状皮瓣供区疗效满意,减少因供区植皮对其他部位造成的损伤,可获得较好外观。     

应用腓肠内侧动脉穿支皮瓣修复下肢软组织缺损

目的总结应用腓肠内侧动脉穿支皮瓣和肌瓣修复下肢软组织缺损的临床应用效果。方法用皮瓣修复胫前区软组织缺损5例,其中,上1/3软组织缺损3例,胫骨中1/3缺损2例,供区均选用同侧小腿。皮瓣切取大小4．0 cm×5．0 cm～5．5 cm×8．0 cm。用肌瓣修复髌前区软组织缺损5例,肌瓣切取大小3．5 cm×4．5 cm～5．5 cm×6．6 cm,肌瓣上行一期中厚网状游离植皮。结果2例术后发生表浅感染,经更换敷料逐渐愈合,皮瓣和肌瓣全部成活,所有病例随访10个月～2．8年(平均1年8个月),没有发现明显的供区功能障碍。受区的外形较好,取得了较满意的效果。结论该皮瓣以腓肠内侧动脉的肌皮穿支为血供,具有血供丰富、血管解剖恒定、血管蒂长以及皮瓣较薄的优点,带蒂移植适宜修复下肢软组织缺损。供区不隐蔽是其缺点。     

两套血供的小腿外侧皮瓣逆行转位修复足踝部软组织缺损

目的 介绍两套血供的改良小腿外侧皮瓣逆行转位修复老年人足踝部软组织缺损的临床体会。 方法 对足踝部软组织缺损、创面骨肌腱外露、需作皮瓣修复的老年病例,在传统的小腿外侧逆行岛状皮瓣及穿支带腓肠神经营养血管逆行岛状皮瓣的基础上,利用小腿外侧皮瓣中下段穿出的骨皮动脉皮支及腓肠神经营养血管皮瓣的供血穿支均发自腓动脉的特点,将皮瓣设计于小腿后外侧,用兼顾传统小腿外侧皮瓣及腓肠神经营养血管皮瓣在供m范围的重叠区域而形成两套血供的改良小腿外侧逆行岛状皮瓣修复。结果临床共应用11例,所有皮瓣术后均顺利成活,供区植皮愈合良好,经3～9个月随访,6例皮瓣外观满意,踝关节伸屈功能正常,基本恢复行走功能;5例合并伸肌腱缺损者3个月后作肌腱移植重建后恢复行走功能。 结论 采用两套血供的改良小腿外侧皮瓣逆行转位是修复老年人足踝部软组织缺损的好方法。     

A novel reconstruction technique for the knee and upper one third of lower leg.

Various reconstructive choices for the coverage of soft tissue defects around the knee joint or upper one third of lower leg are available depending on the location, size and depth of the defect. The authors have found the medial sural artery perforator island flap a useful method for reconstruction of the upper one third of lower leg and knee. From January 2003 to November 2005, medial sural perforator island flaps were used on six patients, five were men and one was a woman. The largest flap obtained was 16 x 7 cm. In three cases, defects were located on the upper one third of lower leg and in the other cases, on the knee. Four of them bone exposed, and two cases had a post-burn contracture. All six flaps survived completely, without even minor complications. Postoperative follow up of the patients ranged from 2 to 33 months. The main advantages of the medial sural perforator island flap are a constant location and reliable blood supply without sacrifice of any main source artery and underlying muscle. This procedure is a valuable extension of local flap for defect coverage with minimal functional deficit of donor site and good aesthetic result on the defect and is a useful method for reconstruction of the upper one third of lower leg and knee.     

The sural artery perforator flap for coverage of defects of the knee and tibia

We reconstructed four knee and lower leg defects using the sural artery perforator flap between 2000 and 2003, and describe them here. The sural artery perforator flap can save the gastrocnemius muscle, its motor nerve, deep fascia, lesser saphenous vein, and sural nerve with no functional loss. Intramuscular dissection of the perforator achieves increased length of the pedicle compared with a conventional gastrocnemius myocutaneous flap. The flap is thin, and either the medial or lateral sural artery may be used. The flap is suitable in selected cases for regional reconstruction around the knee and upper half of the lower leg as a pedicled flap.     

The sural artery perforator flap for coverage of defects of the knee and tibia.

We reconstructed four knee and lower leg defects using the sural artery perforator flap between 2000 and 2003, and describe them here. The sural artery perforator flap can save the gastrocnemius muscle, its motor nerve, deep fascia, lesser saphenous vein, and sural nerve with no functional loss. Intramuscular dissection of the perforator achieves increased length of the pedicle compared with a conventional gastrocnemius myocutaneous flap. The flap is thin, and either the medial or lateral sural artery may be used. The flap is suitable in selected cases for regional reconstruction around the knee and upper half of the lower leg as a pedicled flap.     

Lower leg reconstruction using a sural fasciocutaneous flap

The fasciocutaneous flap in the lower leg has been widely used since Pontén's 1981 report. The cutaneous artery running along the sural nerve--known as the superficial sural artery--has an important role in the blood supply of the fasciocutaneous flap in the lower leg as stated by Haertsch. The superficial sural artery has great variation with regard to its location and the origin of the vessel. The cutaneous artery is intimately connected to the sural nerve or the lateral sural nerve. It may run along the sural nerve or along the lateral sural nerve. We examined this vessel in 10 cadaver dissections and applied it in 17 clinical cases of pedicled, island, and free flaps. The island sural fasciocutaneous flap is particularly versatile for the reconstruction of the soft tissue defect around the knee joint. The operative procedure involving the island fasciocutaneous flap and the characteristics of this sural fasciocutaneous flap are described.     

Lateral sural cutaneous artery island flap in the treatment of soft tissue defects at the knee

This paper describes a flap for covering defects around the knee. Dissections of 20 legs showed that in the majority the lateral sural cutaneous artery branched from the popliteal artery and descended along the posterolateral aspect of the leg together with two venae comitantes and the lateral sural cutaneous nerve. An island flap was designed, pedicled on these vessels and nerve, and was used in 17 patients with defects around the knee, including acute trauma (three cases), soft tissue tumours (three cases), unstable scar or ulcer (seven cases), and chronic osteomyelitis or infected open fractures with tissue loss (four cases). All the flaps survived entirely and possessed normal sensation. Furthermore, it was not necessary to sacrifice the main vessels of the lower leg.     

Pedicled medial sural perforator flap for the reconstruction of knee defects

Soft tissue defects exposing the patellar tendon or bone are common in patients who have experienced trauma or implant infection. The purpose of this article is to present our experience of six patients who underwent reconstruction of soft tissue defects of the knee using a pedicled medial sural perforator flap. Between November 2013 and November 2015, six patients who presented with a soft tissue defect overlying the knee were admitted to our hospital. After adequate debridement or wide excision of the tumour, these patients underwent pedicled medial sural perforator flap placement to resurface the complex soft tissue defects and to provide a gliding surface for the exposed patellar tendon. The patients' age, comorbidity, aetiology, defect size and location, flap size, perforator numbers and lengths, outcome and follow‐up period were reviewed. The six medial sural perforator flaps survived completely, and the wounds healed satisfactorily over a mean follow‐up of 21·5 months (range, 6–51 months). Donor sites were closed primarily or covered with a split‐thickness skin graft. The medial sural perforator flap is a reliable flap for coverage of defects overlying the knee. The thin and pliable flap, long pedicle length and less donor site mobility benefit patients. Thus, the medial sural perforator flap may be a valuable alternative for defect reconstructions overlying the knee, which produces satisfactory results both functionally and cosmetically.     

小腿双岛皮瓣联合修复两处皮肤缺损

目的 探讨同时修复小腿两处皮肤缺损的方法。方法 设计小腿胫前动脉穿支逆行岛状皮瓣与胫后动脉穿支逆行岛状皮瓣联合、内踝上逆行岛状筋膜皮瓣与小腿后侧岛状筋膜皮瓣联合、内踝上逆行岛状筋膜皮瓣与胫前动脉穿支逆行岛状皮瓣联合，分别修复3例小腿两处皮肤缺损。结果 所有皮瓣全部成活，创面闭合。结论 用双岛状皮瓣修复小腿两处皮肤缺损是一个安全、有效、简单的方法。     

Outcomes of the Pedicled Medial Sural Artery Perforator Flap for Soft Tissue Reconstruction Around the Knee: When to Use It and How to Look After It

Introduction  The medial gastrocnemius flap is an established workhorse flap to cover proximal leg defects due to its reliability and simplicity to raise. However, it has the disadvantage of being bulky, requiring a skin graft for coverage, and is associated with loss of muscle power. The pedicled medial sural artery perforator (MSAP) flap has gained popularity as a reconstructive alternative for defects of the lower extremities. We present a case series of pedicled MSAP flaps for reconstructing defects around the knee as an alternative to the medial gastrocnemius flap. Materials and Methods  A consecutive series of patients with proximal leg defects following trauma, osteomyelitis, burns, and chronic wounds were included. A hand-held Doppler was used to map out the MSAPs. Defects were reconstructed using pedicled MSAP flaps, preserving the nerve supply to the gastrocnemius muscle. Patient outcomes were recorded, including their Enneking scores postreconstruction. Results  A total of 10 pedicled flaps was performed to reconstruct defects around the knee joint between October 2017 and November 2018. All the patients were discharged 1 week postoperatively, and rehabilitation consisted of graduated flexion in a knee brace by means of controlled passive mobilization. Three out of the ten patients developed complications: one patient developed flap congestion, one developed epidermolysis of the tip of the flap, and the other patient had partial necrosis of the skin paddle. The average Enneking score was 29 out of 35. Conclusion  The pedicled MSAP flap is a good reconstructive option for proximal leg defects as it is associated with lower donor site morbidity and provides an aesthetically pleasing reconstruction.