Kruris Yumuşak Doku Defektlerinin Rekonstrüksiyonunda Lokal Pediküllü Flepler ile Deneyimimiz

Öz

Amaç: Kruris bölgesindeki yumuşak doku defektleri, sınırlı lokal doku varlığı ve sıklıkla kemik, tendon veya implantların açığa çıkması nedeniyle önemli rekonstrüksiyon zorlukları oluşturur. Bu çalışmanın amacı, kruris yumuşak doku defektlerinin rekonstrüksiyonunda kullanılan lokal pediküllü flepler ile ilgili klinik 
deneyimimizi sunmak ve flep seçimi ile pedikül yönetimine ilişkin pratik yaklaşımları tartışmaktır.
Gereç ve Yöntemler: Bu retrospektif gözlemsel çalışmaya, Ocak 2024 ile Aralık 2025 tarihleri arasında Ankara Bilkent Şehir Hastanesi’nde lokal pediküllü flepler kullanılarak kruris yumuşak doku defekti rekonstrüksiyonu yapılan hastalar dahil edildi. Proksimal bazlı sural arter (PSA) flebi, revers sural arter (RSA) flebi veya posterior tibial arter perforatör (PTAP) tabanlı adipofasiyal turnover flebi ile rekonstrüksiyon uygulanan hastalar çalışmaya alındı. Demografik özellikler, defekt lokalizasyonu ve etiyolojisi, kullanılan flep tipi, komplikasyonlar ve sekonder girişimler değerlendirildi. Birincil sonlanım noktaları flep sağkalımı ve flebe bağlı komplikasyonlar olarak belirlenirken, ikincil sonlanım noktaları donör saha morbiditesi ve deri grefti tutulum oranı olarak değerlendirildi.
Bulgular: Çalışmaya toplam yedi hasta dahil edildi ve ortalama yaş 36,7 yıl (aralık, 18-60 yıl) idi. Rekonstrüksiyonun en sık nedeni travma (n=5) olup bunu tümör rezeksiyonu (n=1) ve osteomiyelit (n=1) izledi. Defektlerin ikisi krurisin proksimal üçte birinde, biri orta üçte birinde ve dördü distal üçte birinde yer almaktaydı. Rekonstrüksiyon iki hastada PSA flebi, dört hastada RSA flebi ve iki hastada PTAP tabanlı adipofasiyal turnover flebi ile gerçekleştirildi. RSA flebi uygulanan hastalardan birinde venöz süperşarj uygulanmıştır. Beş hastada tam flep sağkalımı ile sorunsuz iyileşme sağlandı. Venöz süperşarj uygulanmayan iki RSA flebi olgusunda marjinal distal nekroz gelişti; bu hastalar debridman ve split-thickness deri greftlemesi ile başarılı şekilde tedavi edildi. Hiçbir hastada total flep kaybı gözlenmedi.
Sonuç: Lokal pediküllü flepler, kruris yumuşak doku defektlerinin rekonstrüksiyonunda güvenilir ve pratik seçenekler sunmaktadır. Flep seçiminin defekt lokalizasyonu ve pedikülün ulaşım mesafesi dikkate alınarak yapılması durumunda, mikrovasküler rekonstrüksiyona gerek kalmadan tatmin edici sonuçlar elde edilebilir. Venöz drenajın optimize edilmesi ve titiz postoperatif yönetim komplikasyon oranlarının azaltılmasına katkı sağlayabilir.
 

Anahtar Kelimeler

• Kruris Yumuşak Doku Defekti
• Lokal Pediküllü Flep
• Sural Arter
• Posterior Tibial Arter
• Alt Ekstremite Rekonstrüksiyonu
• Yumuşak Doku Rekonstrüksiyonu

Etik Beyan

Ankara Bilkent City Hospital 1st Medical Research Scientific and Ethical Evaluation Committee prior to data collection (approval date: 11/03/2026; approval number: 1-26-2158).

OUR EXPERIENCE WITH LOCALLY PEDICLED FLAPS IN THE RECONSTRUCTION OF CRURIS SOFT TISSUE DEFECTS

Öz

Objective: Soft tissue defects of the cruris present significant reconstructive challenges because of the limited local tissue availability and frequent exposure of bone, tendon, or hardware. This study aimed to present our clinical experience with locally pedicled flaps used in the reconstruction of cruris soft tissue defects and to discuss practical considerations in flap selection and pedicle management.
Material and Methods: This retrospective observational study included patients who underwent reconstruction of cruris soft tissue defects with locally pedicled flaps at Ankara Bilkent City Hospital between January 2024 and December 2025. Patients reconstructed with proximally based sural artery (PSA) flaps, reverse sural artery (RSA) flaps, or posterior tibial artery perforator (PTAP)-based adipofascial turnover flaps were included. Demographic characteristics, defect location and etiology, flap type, complications, and secondary procedures were evaluated. Primary outcomes included flap survival and flap-related complications, while secondary outcomes included donor-site morbidity and skin graft take.
Results: Seven patients were included in the study, with a mean age of 36.7 years (range, 18-60 years). The most common indication for reconstruction was trauma (n=5), followed by tumor resection (n=1) and osteomyelitis (n=1). Two defects were located in the proximal third of the cruris, one in the middle third, and four in the distal third. Reconstruction was performed using PSA flaps in two patients, RSA flaps in four patients, and PTAP adipofascial turnover flaps in two patients. One RSA flap was augmented with venous supercharging. Complete flap survival was achieved in five patients. Two RSA flap cases without venous supercharging developed marginal distal necrosis, which was successfully managed with debridement and split-thickness skin grafting. No total flap loss occurred.
Conclusion: Locally pedicled flaps represent reliable and practical options for the reconstruction of cruris soft tissue defects. When flap selection is guided by defect location and pedicle reach, satisfactory outcomes can be achieved without the need for microsurgical reconstruction. Attention to venous drainage 
and meticulous postoperative management may further reduce complication rates.

Anahtar Kelimeler

• Cruris Soft Tissue Defect
• Locally Pedicled Flap
• Sural Artery
• Posterior Tibial Artery
• Lower Ex- tremity Reconstruction
• Soft Tissue Reconstruction

Etik Beyan

Ankara Bilkent City Hospital 1st Medical Research Scientific and Ethical Evaluation Committee prior to data collection (approval date: 11/03/2026; approval number: 1-26-2158).

Kaynakça

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