• 上海長征醫(yī)院整形外科（上海，200003）;

目的 總結用于膝周軟組織缺損修復的皮瓣、筋膜瓣、肌瓣及肌皮瓣的研究進展，為臨床應用提供參考。 方法查閱近年國內外有關膝周軟組織缺損修復的文獻，進行總結分析。 結果筋膜皮瓣符合膝周軟組織重建需皮瓣薄、柔軟而堅韌的要求；肌（皮）瓣可以充填殘腔，血供豐富，抗感染能力更強；游離皮瓣是局部或鄰位皮瓣無法利用時的一種選擇。 結論臨床應根據(jù)膝區(qū)不同缺損部位、深度和范圍選擇合適皮瓣修復軟組織缺損，筋膜皮瓣因供區(qū)損傷小、重建外形良好，可作為首選。

引用本文： 章杰,蘆立軒,江華. 膝周軟組織缺損修復的研究進展. 中國修復重建外科雜志, 2012, 26(9): 1138-1141. doi: 復制

1. Panni AS, Vasso M, Cerciello S, et al. Wound complications in total knee arthroplasty. Which flap is to be used? With or without retention of prosthesis? Knee Surg Sports Traumatol Arthrosc, 2011, 19(7): 1060-1068.
2. Manoso MW, Boland PJ, Healey JH, et al. Limb salvage of infected knee reconstructions for cancer with staged revision and free tissue transfer. Ann Plast Surg, 2006, 56(5): 532-535.
3. Barfod B, Pers M. Gastrocnemius-plasty for primary closure of compound injuries of the knee. J Bone Joint Surg (Br), 1970, 52(1): 124-127.
4. Veber M, Vaz G, Braye F, et al. Anatomical study of the medial gastrocnemius muscle flap: a quantitative assessment of the arc of rotation. Plast Reconstr Surg, 2011, 128(1): 181-187.
5. Casanova D, Hulard O, Zalta R, et al. Management of wounds of exposed or infected knee prostheses. Scand J Plast Reconstr Surg Hand Surg, 2001, 35(1): 71-77.
6. Boopalan PR, Nithyananth M, Jepegnanam TS. Lateral gastrocnemius flap cover for distal thigh soft tissue loss. J Trauma, 2010, 69(5): E38-41.
7. Busfield BT, Huffman GR, Nahai F, et al. Extended medial gastrocnemius rotational flap for treatment of chronic knee extensor mechanism deficiency in patients with and without total knee arthroplasty. Clin Orthop Relat Res, 2004, (428): 190-197.
8. Patel NS, Ibrahim DT, Finn HA. Knee extensor mechanism reconstruction with medial gastrocnemius flap. Clin Orthop Relat Res, 2002, (398): 176-181.
9. Ries MD, Bozic KJ. Medial gastrocnemius flap coverage for treatment of skin necrosis after total knee arthroplasty. Clin Orthop Relat Res, 2006, (446): 186-192.
10. Tiengo C, Macchi V, Vigato E, et al. Reversed gracilis pedicle flap for coverage of a total knee prosthesis. J Bone Joint Surg (Am), 2010, 92(7): 1640-1646.
11. McCraw JB, Fishman JH, Sharzer LA. The versatile gastrocnemius myocutaneous flap. Plast Reconstr Surg, 1978, 62(1): 15-23.
12. Ger R. Closure of defects of the lower extremity by muscle flaps//Converse JM. Reconstructive plastic surgery. Philadelphia: WB Saunders Company, 1977: 3558.
13. Fayman MS, Orak F, Hugo B, et al. The distally based split soleus muscle flap. Br J Plast Surg, 1987, 40(1): 20-26.
14. Zheng H, Wang H, Zhang F, et al. Anatomic basis of perforator flaps of medial vastus muscle. Microsurgery, 2007, 28(1): 61-64.
15. Siebert CH, Höfler HR, Bruns J, et al. Reversed musculus biceps femoris flap for covering a defect of the distal thigh. Chirurg, 1996, 67(11): 1188-1192.
16. Nguyen AT, Wong C, Mojallal A, et al. Lateral supragenicular pedicle perforator flap: clinical results and vascular anatomy. J Plast Reconstr Aesthet Surg, 2011, 64(3): 381-385.
17. Hayashi A, Maruyama Y. The lateral genicular artery flap. Ann Plast Surg, 1990, 24(4): 310-317.
18. Spokevicius S, Jankauskas A. Anatomy and clinical applications of a composite cutaneo-subcutaneous flap based on the lateral superior genicular vessels. J Reconstr Microsurg, 1995, 11(1): 15-20.
19. Wiedner M, Koch H, Scharnagl E. The superior lateral genicular artery flap for soft-tissue reconstruction around the knee: clinical experience and review of the literature. Ann Plast Surg, 2011, 66(4): 388-392.
20. 徐達傳, 鐘世鎮(zhèn), 劉牧之, 等. 股前外側部皮瓣的解剖學: 一個新的游離皮瓣供區(qū). 臨床應用解剖學雜志, 1984, 2(3): 158-160.
21. 羅力生, 高建華, 陳林峰, 等. 股前外側皮瓣及其游離移植的應用. 第一軍醫(yī)大學學報, 1984, 4(1、2): 1-4.
22. Kim JS, Lee HS, Jang PY, et al. Use of the descending branch of lateral circumflex femoral artery as a recipient pedicle for coverage of a knee defect with free flap: anatomical and clinical study. Microsurgery, 2010, 30(1): 32-36.
23. Shieh SJ, Chiu HY, Yu JC. Free anterolateral thigh flap for reconstruction of head and neck defects following cancer ablation. Plast Reconstr Surg, 2000, 105(7): 2349-2360.
24. Pan SC, Yu JC, Shieh SJ, et al. Distally based anterolateral thigh flap: an anatomic and clinical study. Plast Reconstr Surg, 2004, 114(7): 1768-1775.
25. Wang XC, Lu Q, Li XF, et al. Reversed anterolateral thigh adipofascial flap for knee and proximal calf defects. Burns, 2008, 34(6): 868-872.
26. Liu TY, Jeng SF, Yang JC, et al. Reconstruction of the skin defect of the knee using a reverse anterolateral thigh island flap: case report. Ann Plast Surg, 2010, 64(2): 198-201.
27. Demirseren ME, Efendioglu K, Demiralp CO, et al. Clinical experience with a reverse-flow anterolateral thigh perforator flap for the reconstruction of soft-tissue defects of the knee and proximal lower leg. J Plast Reconstr Aesthet Surg, 2011, 64(12): 1613-1620.
28. Hallock GG. The medial sural (MEDIAL GASTROCNEMIUS) perforator local flap. Ann Plast Surg, 2004, 53(5): 501-505.
29. Kim HH, Jeong JH, Seul JH, et al. New design and identiflcation of the medial sural perforator flap: an anatomical study and its clinical applications. Plast Reconstr Surg, 2006, 117(5): 1609-1618.
30. Shim JS, Kim HH. A novel reconstruction technique for the knee and upper one third of lower leg. J Plast Reconstr Aesthet Surg, 2006, 59(9): 919-926.
31. Cheon SJ, Kim IB, Park WR, et al. The proximally-based sural artery flap for coverage of soft tissue defects around the knee and on the proximal third and middle third of the lower leg: 10 patients followed for 1-2.5 years. Acta Orthop, 2008, 79(3): 370-375.
32. Park S, Eom JS. Selection of the recipient vessel in the free flap around the knee: the superior medial genicular vessels and the descending genicular vessels. Plast Reconstr Surg, 2001, 107(5): 1177-1182.
33. Beumer JD, Karoo R, Caplash Y, et al. The medial sural artery as recipient vessel and the impact on the medial gastrocnemius. Ann Plast Surg, 2011, 67(4): 382-386.
34. Hong JP, Koshima I. Using perforators as recipient vessels (supermicrosurgery) for free flap reconstruction of the knee region. Ann Plast Surg, 2010, 64(3): 291-293.
  1. 1. Panni AS, Vasso M, Cerciello S, et al. Wound complications in total knee arthroplasty. Which flap is to be used? With or without retention of prosthesis? Knee Surg Sports Traumatol Arthrosc, 2011, 19(7): 1060-1068.
  2. 2. Manoso MW, Boland PJ, Healey JH, et al. Limb salvage of infected knee reconstructions for cancer with staged revision and free tissue transfer. Ann Plast Surg, 2006, 56(5): 532-535.
  3. 3. Barfod B, Pers M. Gastrocnemius-plasty for primary closure of compound injuries of the knee. J Bone Joint Surg (Br), 1970, 52(1): 124-127.
  4. 4. Veber M, Vaz G, Braye F, et al. Anatomical study of the medial gastrocnemius muscle flap: a quantitative assessment of the arc of rotation. Plast Reconstr Surg, 2011, 128(1): 181-187.
  5. 5. Casanova D, Hulard O, Zalta R, et al. Management of wounds of exposed or infected knee prostheses. Scand J Plast Reconstr Surg Hand Surg, 2001, 35(1): 71-77.
  6. 6. Boopalan PR, Nithyananth M, Jepegnanam TS. Lateral gastrocnemius flap cover for distal thigh soft tissue loss. J Trauma, 2010, 69(5): E38-41.
  7. 7. Busfield BT, Huffman GR, Nahai F, et al. Extended medial gastrocnemius rotational flap for treatment of chronic knee extensor mechanism deficiency in patients with and without total knee arthroplasty. Clin Orthop Relat Res, 2004, (428): 190-197.
  8. 8. Patel NS, Ibrahim DT, Finn HA. Knee extensor mechanism reconstruction with medial gastrocnemius flap. Clin Orthop Relat Res, 2002, (398): 176-181.
  9. 9. Ries MD, Bozic KJ. Medial gastrocnemius flap coverage for treatment of skin necrosis after total knee arthroplasty. Clin Orthop Relat Res, 2006, (446): 186-192.
  10. 10. Tiengo C, Macchi V, Vigato E, et al. Reversed gracilis pedicle flap for coverage of a total knee prosthesis. J Bone Joint Surg (Am), 2010, 92(7): 1640-1646.
  11. 11. McCraw JB, Fishman JH, Sharzer LA. The versatile gastrocnemius myocutaneous flap. Plast Reconstr Surg, 1978, 62(1): 15-23.
  12. 12. Ger R. Closure of defects of the lower extremity by muscle flaps//Converse JM. Reconstructive plastic surgery. Philadelphia: WB Saunders Company, 1977: 3558.
  13. 13. Fayman MS, Orak F, Hugo B, et al. The distally based split soleus muscle flap. Br J Plast Surg, 1987, 40(1): 20-26.
  14. 14. Zheng H, Wang H, Zhang F, et al. Anatomic basis of perforator flaps of medial vastus muscle. Microsurgery, 2007, 28(1): 61-64.
  15. 15. Siebert CH, Höfler HR, Bruns J, et al. Reversed musculus biceps femoris flap for covering a defect of the distal thigh. Chirurg, 1996, 67(11): 1188-1192.
  16. 16. Nguyen AT, Wong C, Mojallal A, et al. Lateral supragenicular pedicle perforator flap: clinical results and vascular anatomy. J Plast Reconstr Aesthet Surg, 2011, 64(3): 381-385.
  17. 17. Hayashi A, Maruyama Y. The lateral genicular artery flap. Ann Plast Surg, 1990, 24(4): 310-317.
  18. 18. Spokevicius S, Jankauskas A. Anatomy and clinical applications of a composite cutaneo-subcutaneous flap based on the lateral superior genicular vessels. J Reconstr Microsurg, 1995, 11(1): 15-20.
  19. 19. Wiedner M, Koch H, Scharnagl E. The superior lateral genicular artery flap for soft-tissue reconstruction around the knee: clinical experience and review of the literature. Ann Plast Surg, 2011, 66(4): 388-392.
  20. 20. 徐達傳, 鐘世鎮(zhèn), 劉牧之, 等. 股前外側部皮瓣的解剖學: 一個新的游離皮瓣供區(qū). 臨床應用解剖學雜志, 1984, 2(3): 158-160.
  21. 21. 羅力生, 高建華, 陳林峰, 等. 股前外側皮瓣及其游離移植的應用. 第一軍醫(yī)大學學報, 1984, 4(1、2): 1-4.
  22. 22. Kim JS, Lee HS, Jang PY, et al. Use of the descending branch of lateral circumflex femoral artery as a recipient pedicle for coverage of a knee defect with free flap: anatomical and clinical study. Microsurgery, 2010, 30(1): 32-36.
  23. 23. Shieh SJ, Chiu HY, Yu JC. Free anterolateral thigh flap for reconstruction of head and neck defects following cancer ablation. Plast Reconstr Surg, 2000, 105(7): 2349-2360.
  24. 24. Pan SC, Yu JC, Shieh SJ, et al. Distally based anterolateral thigh flap: an anatomic and clinical study. Plast Reconstr Surg, 2004, 114(7): 1768-1775.
  25. 25. Wang XC, Lu Q, Li XF, et al. Reversed anterolateral thigh adipofascial flap for knee and proximal calf defects. Burns, 2008, 34(6): 868-872.
  26. 26. Liu TY, Jeng SF, Yang JC, et al. Reconstruction of the skin defect of the knee using a reverse anterolateral thigh island flap: case report. Ann Plast Surg, 2010, 64(2): 198-201.
  27. 27. Demirseren ME, Efendioglu K, Demiralp CO, et al. Clinical experience with a reverse-flow anterolateral thigh perforator flap for the reconstruction of soft-tissue defects of the knee and proximal lower leg. J Plast Reconstr Aesthet Surg, 2011, 64(12): 1613-1620.
  28. 28. Hallock GG. The medial sural (MEDIAL GASTROCNEMIUS) perforator local flap. Ann Plast Surg, 2004, 53(5): 501-505.
  29. 29. Kim HH, Jeong JH, Seul JH, et al. New design and identiflcation of the medial sural perforator flap: an anatomical study and its clinical applications. Plast Reconstr Surg, 2006, 117(5): 1609-1618.
  30. 30. Shim JS, Kim HH. A novel reconstruction technique for the knee and upper one third of lower leg. J Plast Reconstr Aesthet Surg, 2006, 59(9): 919-926.
  31. 31. Cheon SJ, Kim IB, Park WR, et al. The proximally-based sural artery flap for coverage of soft tissue defects around the knee and on the proximal third and middle third of the lower leg: 10 patients followed for 1-2.5 years. Acta Orthop, 2008, 79(3): 370-375.
  32. 32. Park S, Eom JS. Selection of the recipient vessel in the free flap around the knee: the superior medial genicular vessels and the descending genicular vessels. Plast Reconstr Surg, 2001, 107(5): 1177-1182.
  33. 33. Beumer JD, Karoo R, Caplash Y, et al. The medial sural artery as recipient vessel and the impact on the medial gastrocnemius. Ann Plast Surg, 2011, 67(4): 382-386.
  34. 34. Hong JP, Koshima I. Using perforators as recipient vessels (supermicrosurgery) for free flap reconstruction of the knee region. Ann Plast Surg, 2010, 64(3): 291-293.