Composite tissue flap at perforating branches of saphenous artery: a new design for repairing composite tissue defects in anterior knee.

IF 0.2 Q4 MEDICINE, RESEARCH & EXPERIMENTAL
International journal of clinical and experimental medicine Pub Date : 2015-11-15 eCollection Date: 2015-01-01
Guangfeng Sun, Kaiyu Nie, Wenhu Jin, Zairong Wei, Jianping Qi, Dali Wang
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Abstract

So far it has been difficult to repair and reconstruct the composite tissue defects in knee. Saphenous artery flap has been widely used to repair complex wounds, but the design and clinical application of composite tissue flap at perforating branches of saphenous artery were not reported. In this research, we design a new composite tissue flap by carrying fascial flap in the medial gastrocnemius muscle with perforators flap in saphenous artery to repair and reconstruct the composite tissue defects in knee. By anatomic observation and analysis, we find that there exists blood-supply in netty form among saphenous arteries, medial artery below the knee, intermuscular branch in high-order position of posterior tibial artery and perforating branch in medial artery of calf. We chose saphenous artery as blood-supplying artery; utilized the netty blood-supplying mode in middle-up and medial part of shank; cut the composite tissue flap at perforating branches of saphenous artery with fascial flap carried in the medial gastrocnemius muscle; reconstructed the ligamentum patellae using medial head of gastrocnemius muscle and Achilles's tendon; and covered the wounds at front side of knee with flap. Composite tissues were survived completely, free from infection at wounds and exosmosis of joint fluid. Motion function of knee-joint proved satisfactory, and ambulatory function was recovered. There was no complication in donor site. Composite tissue flap at perforating branches of saphenous artery with fascial flap carried in the medial gastrocnemius muscle is one of the most ideal solutions for repairing the composite tissue defects at front side of knee joint.

隐动脉穿支复合组织瓣:修复膝关节前部复合组织缺损的新设计。
迄今为止,膝关节复合组织缺损的修复和重建一直是个难题。大隐动脉瓣已被广泛应用于修复复杂创面,但在大隐动脉穿孔支处设计复合组织瓣并应用于临床的研究尚未见报道。在这项研究中,我们设计了一种新的复合组织瓣,将腓肠肌内侧筋膜瓣与隐动脉穿孔瓣结合起来,修复和重建膝关节的复合组织缺损。通过解剖观察和分析,我们发现隐动脉、膝下内侧动脉、胫后动脉高位肌间支和小腿内侧动脉穿孔支之间存在网状血供。我们选择大隐动脉作为供血动脉,利用小腿中上部和内侧的网状供血模式,在大隐动脉穿孔支处切取复合组织瓣,并在腓肠肌内侧带入筋膜瓣,利用腓肠肌内侧头和跟腱重建髌韧带,用皮瓣覆盖膝关节前侧的伤口。复合组织完全存活,伤口无感染,关节液无渗出。膝关节的活动功能令人满意,活动功能得到恢复。供体部位无并发症。大隐动脉穿支复合组织瓣和腓肠肌内侧筋膜瓣是修复膝关节前侧复合组织缺损的最理想方案之一。
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