腓肠肌皮瓣在膝关节重建中的作用:适应证和缺陷

IF 1.3 Q3 SURGERY
Archives of Plastic Surgery-APS Pub Date : 2023-08-24 eCollection Date: 2023-11-01 DOI:10.1055/s-0043-1768644
Gianluca Sapino, Rik Osinga, Michele Maruccia, Martino Guiotto, Martin Clauss, Olivier Borens, David Guillier, Pietro Giovanni di Summa
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引用次数: 0

摘要

摘要背景 膝关节周围的软组织重建仍然是一个悬而未决的问题,特别是在持续感染和多次再次手术的情况下。即使植入异物,皮瓣覆盖也应确保关节活动性和保护性。以腓肠动脉穿支为基础的腓肠肌肌皮皮瓣的嵌合收获,可以扩大其在上肢软组织重建中的适用性,克服其他带蒂皮瓣的缺点。方法 进行了一项多中心回顾性研究,纳入了2018年至2021年在全膝关节置换术(TKA)复发性感染和上肢肿瘤或创伤缺陷中接受带蒂、嵌合腓肠肌皮-腓肠内侧动脉穿支(GM-MSAP)或腓肠外侧动脉穿支(GM-LSAP)皮瓣膝盖覆盖的患者。评估的结果是成功的软组织重建和皮瓣并发症。讨论了手术时机、重建计划、技术和康复方案。后果 21名患者被纳入研究。进行了19次GM MSAP和2次GM LSAP(感染TKA[12]、感染硬件[4]和肿瘤学患者[5]的软组织重建)。9例主要关闭了供区,而12例需要植皮。皮瓣伤口裂开(1)、远端皮瓣坏死(1。与植入物交换或广泛清创术相关的皮瓣重建是成功的,无需任何进一步的皮瓣手术。结论 螺旋桨-穿孔器GM-MSAP由于皮肤的可用性和松弛性,提供了定性的缺陷覆盖和多个皮瓣的容易复位。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Role of the Gastrocnemius Musculocutaneous with a Propeller Style Skin Flap in Knee Region Reconstruction: Indications and Pitfalls.

Background  Soft tissue reconstruction around the knee area is still an open question, particularly in persistent infections and multiple reoperations scenario. Flap coverage should guarantee joint mobility and protection, even when foreign materials are implanted. The chimeric harvesting of the musculocutaneous gastrocnemius flap, based on the sural artery perforators, can extend its applicability in soft tissue reconstruction of the upper leg, overcoming the drawbacks of the alternative pedicled flaps. Methods  A multicenter retrospective study was conducted enrolling patients who underwent to a pedicled, chimeric gastrocnemius musculocutaneous-medial sural artery perforator (GM-MSAP) or lateral sural artery perforator (GM-LSAP) flap for knee coverage in total knee arthroplasty (TKA) recurrent infections and oncological or traumatic defects of the upper leg from 2018 to 2021. Outcomes evaluated were the successful soft tissue reconstruction and flap complications. Surgical timing, reconstruction planning, technique, and rehabilitation protocols were discussed. Results  Twenty-one patients were included in the study. Nineteen GM-MSAPs and 2 GM-LSAPs were performed (soft tissue reconstruction in infected TKA [12], in infected hardware [4], and in oncological patients [5]). Donor site was closed primarily in 9 cases, whereas a skin graft was required in 12. Flap wound dehiscence (1), distal flap necrosis (1), distal necrosis of the skin paddle (1), and donor site infection (1) were the encountered complications. Flap reraise associated to implant exchange or extensive debridement was successful without requiring any further flap surgery. Conclusion  The propeller-perforator GM-MSAP offers qualitative defect coverage and easiness of multiple flap reraise due to skin availability and its laxity.

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来源期刊
CiteScore
2.10
自引率
6.70%
发文量
131
审稿时长
10 weeks
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