Komplike Olgularda Diz Ve Çevresi Yumuşak Doku Defektlerinin Distal Anteromedial Perforatör Uyluk Flebi İle Kapatılması

Year 2020, Volume: 8 Issue: 2, 145 - 151, 23.08.2020

Muhammed Besir Ozturk

https://doi.org/10.37696/nkmj.650983

Abstract

Özler

Amaç:
Diz ve çevresi yumuşak doku rekonstrüksiyonunda
ekspoze yapıların yeterli yumuşak dokuyla örtülmesi gerekliliği yanında diz
fonksiyonunun korunması da önemlidir.Diz çevresi cilt defektleri
için çok çeşitli flepler tarif edilmiştir. İleri yaşlı, eşlik eden
komorbiditeleri olan ve lokal flep seçenekleri kısıtlı olan olgularda ise
çapraz bacak flebi dışında iyi bir alternatif bulmak zordur. Distal
anteromedial uyluk flebi klasik tanımlanmış fleplerin dışında diz ve çevresi
cilt defektlerinin rekonstrüksiyonu için iyi bir lokal alternatif flep seçeneği
sunmaktadır.

Materyal
metot: 2014-2019 yılları arasında diz ve diz çevresi
cilt defektleri için opere ettiğimiz üç kadın üç erkek toplam altı hasta bu çalışmaya
dahil edildi. Bu hastaların dördü yaşlı ve eşlik eden çoklu ek hastalıkları
mevcut iken iki hastada ise geçirilmiş kompartman sendromu ve nekrotizan
fasiite bağlı lokal flep seçenekleri kısıtlıydı.

Bulgular:
Bir hasta hariç tüm hastalarımızda defektler başarılı
bir şekilde kapatıldı. Yüzeysel marjinal nekroz gelişen hastamızda kalan defekt
sorunsuz şekilde greftlendi. Parsiyel %40 nekroz gelişen hastamızda patella
üzeri defekt kapatılabilirken pretibial bölge üzeri kapatılamadı ve çapraz
bacak flebi planlandı.

Sonuç: Distal anteromedial uyluk perforatör flebi rekonstrüksiyonu
zor diz ve çevresi cilt defektlerinde kullanılabilecek iyi bir seçenektir.
Patella altına ulaşan defektlerde delay yapılarak kullanılması venöz yetmezliği
engellemek için uygun olabilir.

 

Abstract:

Objective:  In soft tissue
reconstruction of the knee and its surrounding tissue, it is important to cover
the exposed structures with sufficient soft tissue and to protect the knee
function. A wide range of flaps have been described for skin defects around the
knee. In elderly patients with multiple comorbidities and in patients with
limited local flap options, it is difficult to find a good alternative except
for the cross-leg flap. The distal anteromedial thigh flap provides a good
local alternative flap option for the reconstruction of knee and peripatellar
skin defects other than classical defined flaps.

Material and Methods: Six patients (three females, three males) who were
operated for knee and peripatellar skin defects between 2014-2019 were included
in this study. Four of these patients were elderly and had multiple
comorbidities, whereas two patients had limited local flap options due to
previous compartment syndrome and necrotizing fasciitis.

Results: The defects were successfully closed in all patients except
one. In one of our patient who developed superficial marginal necrosis, the
remaining defect was grafted without any problem. The other patient who
developed partial 40% necrosis, the patellar defect was closed but the
pretibial region could not be closed and a cross leg flap was planned.

Conclusion: Distal anteromedial thigh perforator flap is a good option
for reconstruction of knee and peripatellar skin defects in complicated cases.
It may be appropriate to use the delayed flap for the defects of infrapatellar
region to prevent venous insufficiency.

Keywords

distal anteromedial thigh flap, peripatellar soft tissue reconstruction, diz ve çevresi yumuşak doku rekonstrüksiyonu, distal anteromedial uyluk flebi

Supporting Institution

yok

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