膝降动脉作为游离股前外侧皮瓣受区血管的临床应用

目的　探讨胫前或胫后血管均无法利用的情况下将膝降动脉作为游离股前外侧皮瓣移植修复膝关节周围创面受区血管的临床可行性应用。 方法　2015年1月至2017年5月，应用于膝降动脉和大隐静脉吻合的游离股前外侧皮瓣移植修复7例膝关节周围大面积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，皮瓣面积为38 cm×8 cm~18 cm×8 cm。 结果　随访6~14个月，平均8.9个月，2例面积较大皮瓣远端分别坏死约6 cm、4 cm，经切除后与残留创面二期植皮愈合，剩余5例皮瓣完全成活，受区残留创面二期植皮愈合。 结论　术前经彩色多普勒超声精确定位并测量膝降动脉口径、血流，术中采用显微外科技术扩大膝降动脉口径，可将膝降动脉作为游离股前外侧皮瓣受区血管修复膝关节周围软组织缺损创面，并取得满意的临床疗效。

Clinical application of the descending genicular artery as the recipient artery for free anterolateral thigh flap

Objective 　To investigate the clinical feasibility of using the descending genicular artery as the recipient artery when the anterior or posterior tibial artery cannot be used to repair the wound around the knee joint by the free anterolateral thigh flap. Method From January 2015 to May 2017, the application of the descending artery and great saphenous vein as the recipient vessels for the anterolateral thigh flaps for resurfacing of large-sized skin and soft-tissue defects complicated with bone and tendon exposure around the knee in 7 cases. among the 7 cases, 4 were the male, and 3 female . The flap size ranged from 18 cm × 8 cm to 38 cm × 8 cm. Results All patients were followed up for 6~14 months, with an average of 8.9 months. Two largest flaps had necrosis at about 6 cm and 4 cm proximal to the distal margin of the flap, respectively. After the resection, the residual wound were healed with secondly skin grafting. Conclusion Preoperative accurate positioning through color Doppler ultrasound and measurement of the diameter of the descending genicular artery, blood flow, the use of intraoperative microsurgical techniques to expand the diameter of the descending genicular artery, the descending genicular artery can be used as the recipient artery for the free anterolateral thigh flap intended for resurfacing of soft-tissue defecst around the knee, and satisfactory clinical efficacy can be achieved.