摘要目的 探讨胫前或胫后血管无法利用的情况下将膝降动脉作为受区血管的股前外侧皮瓣移植修复膝关节周围创面的临床应用.方法 2015年1月至2017年5月,经术前彩色多普勒超声(CDU)定位,应用吻合膝降动脉和大隐静脉的游离股前外侧皮瓣移植修复7例膝关节周围皮肤软组织缺损合并肌腱、骨外露的患者,其中男4例,女3例,皮瓣面积18.0 cm×8.0 cm～38.0 cm×8.0 cm,供区均直接缝合.定期进行随访.结果 所有患者均获得随访,随访时间6～14个月,平均8.9个月.2例面积较大皮瓣远端分别坏死6.0 cm、4.0 cm,经切除后与残留创面二期植皮愈合.4例皮瓣完全成活,残留创面二期植皮愈合.剩余1例皮瓣完全成活,但皮瓣远端靠胫前内侧由于并发骨髓炎而继发骨外露,再次行腓肠肌内侧头肌皮瓣移植修复创面愈合.结论 以膝降动脉作为受区血管的股前外侧皮瓣移植修复膝关节周围皮肤软组织缺损创面,可取得满意的临床疗效,并可作为膝关节周围创面皮瓣修复的一种选择.

abstractsObjective To explore the clinical application of antcrolateral thigh flap transplantation in repairing wound around the knee with descending genicular artery as the recipient vessel,when anterior or posterior tibial vessel could not be utilized.Methods From January,2015 to May,2017,free anterolateral thigh flaps obtained from anastomosis of descending genicular artery and great saphenous vein were transplanted to repair the skin soft tissue defect around the knee combined with tendon and bone exposure in 7 patients,after preoperative color Doppler sonography ultrasound (CDU) for precise positioning.There were 4 males and 3 females,with the flap area ranging from 18.0 cm×8.0 cm-38.0 cm×8.0 cm.All of the donor sites were sutured directly.Postoperative followedup was done termly.Results All the patients were followed-up for 6 to 14 months,with an average of 8.9 months.Typically,2 cases had large defect areas,with distal flap necrosis of 6.0 cm and 4.0 cm,respectively,which were resected and achieved secondary skin graft healing on the residual surface.Additionally,4 cases had completely survived flaps and achieved secondary skin graft healing on the residual surface.The remaining 1 case had completely survived flap,but the distal flap near the anteromedial tibia developed bone exposure as a result of the complicated osteomyelitis.As a result,the patient received gastrocnemius myocutaneous flap to repair the wound.Conclusion Anterolateral thigh flap transplantation in repairing skin soft tissue defect wound around the knee,with descending genicular artery as the recipient vessel,can achieve satisfactory clinical efficacy,which can serve as one choice for flap repair in wound around the knee.