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

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.

Anahtar Kelimeler:

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

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