KOMPLİKE OLGULARDA DİZ VE ÇEVRESİ YUMUŞAK DOKU DEFEKTLERİNİN DİSTAL ANTEROMEDİAL PERFORATÖR UYLUK FLEBİ İLE KAPATILMASI

fonksiyonunun korunması da önemlidir. Diz çevresi cilt defektleri için çok çeşitli flepler tarif edilmiştir. İleri yaşlı, eşlik eden komorbiditeleriolan ve lokal flep seçenekleri kısıtlı olan olgularda ise çapraz bacak flebi dışında iyi bir alternatif bulak zordur. Distal anteromedial uylukflebi klasik tanımlanmış fleplerin dışında diz ve çevresi cilt defektlerinin rekonstrüksiyonu için iyi bir lokal alternatif flep seçeneğisunmaktadır. Bu çalışmada komplike hastalarda diz bölgesi yumuşak doku defektlerinin distal anteromedial uyluk flebi ilerekonstrüksiyon sonuçları sunulmuştur.Materyal ve Metot: 2014-2019 yılları arasında diz ve diz çevresi cilt defektleri için opere ettiğimiz üç kadın üç erkek toplam altı hasta buçalışmaya dahil edildi. Bu hastaların dördü yaşlı ve eşlik eden çoklu ek hastalıkları mevcut iken iki hastada geçirilmiş kompartmansendromu ve nekrotizan fasiite bağlı lokal flep seçenekleri kısıtlıydı.Bulgular: Bir hasta hariç tüm hastalarımızda defektler başarılı bir şekilde kapatıldı. Yüzeysel marjinal nekroz gelişen hastamızda kalandefekt sorunsuz şekilde greftlendi. Parsiyel %40 nekroz gelişen hastamızda patella üzeri defekt kapatılabilirken pretibial bölge üzerikapatılamadı ve çapraz bacak flebi planlandı.Sonuç: Distal anteromedial uyluk perforatör flebi komplike hastalarda diz ve çevresi cilt defektlerinde kullanılabilecek güvenli birseçenektir. Patella altına ulaşan defektlerde delay yapılarak kullanılması venöz yetmezliği engellemek için uygun olabilir.

The Use of Distally Based Anteromedial Thigh Perforator Flap in Complicated Peripatellar Soft Tissue Reconstructions

Aim: 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. 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. In this study, reconstruction results of complicated soft tissue defects of knee region with distal anteromedial thigh flap are presented. Materials 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 successfully. 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 safe 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.

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1. Misra A, Niranjan NS. Fasciocutaneous flaps based on fascial feeder and perforator vessels for defects in the patellar and peripatellar regions. Plast Reconstr Surg. 2005;115:1625-32.
2. Zheng HP, Zhuang YH, Lin J1, Zhang YX, Levin LS, Grassetti L, Lazzeri D, Persichetti . Revisit of the anatomy of the distal perforator of the descending genicular artery and clinical application of its perforator "propeller" flap in the reconstruction of soft tissue defects around the knee. Microsurgery. 2015;35(5):370-9.
3. Arnold PG, Prunes-Carrillo F. Vastus medialis muscle flap for functional closure of the exposed knee joint. Plast Reconstr Surg. 1981; 68(1):69-72.
4. Swartz WM, Ramasastry SS, Mc Gill JR, Noonan JD. Distally based vastus lateralis muscle flap for coverage of wounds about the knee. Plast Reconstr Surg. 1987;80(2):255-65.
5. Tobin GR. Vastus medialis myocutaneous and myocutaneoustendinous composite flaps. Plast Reconstr Surg. 1985;75(5):677–684.
6. Petty CT, Hogue RJ Jr. Closure of an exposed knee joint by use of a sartorius muscle flap: Case report. Plast Reconstr Surg. 1978;62(3):458–61.
7. Feldman JJ, Cohen BE, May JW Jr. The medial gastrocnemius myocutaneous flap. Plast Reconstr Surg. 1978;61(4):531– 539.
8. Lu LJ, Gong X, Cui JL, Liu B. The anteromedial thigh fasciocutaneous flap pedicled on the supragenicular septocutaneous perforator: Application in 11 patients. Ann Plast Surg. 2011;67(3):275–78.
9. Acland RD, Schusterman M, Godina M, Eder E, Taylor GI, Carlisle I. The saphenous neurovascular free flap. Plast Reconstr Surg. 1981; 67(6):763-74.
10. Hayashi A, Maruyama Y. The medial genicular artery flap. Ann Plast Surg. 1990;25(3):174–80.
11. Bertelli JA. The saphenous postero-medial island thigh flap and the saphenous supero-medial cutaneous island leg flap. Surg Radiol Anat. 1992;14(2):187-9.
12. Hallock GG. Local knee random fasciocutaneous flaps. Ann Plast Surg. 1989;23(24):289-96. 13. Fisher J, Cooney WP III. Designing the latissimus dorsi free flap for knee coverage. Ann Plast Surg. 1983;11(6):554–562.
14. Yuen JC, Zhou AT. Free flap coverage for knee salvage. Ann Plast Surg 1996;37(2):158–-66.
15. Bhattacharya V, Reddy GR. Retrograde perforator-based cross-leg fasciocutaneous flaps for distal leg and foot defects. Plast ReconstrSurg. 2006;117(5):1662–64.
16. Lazzeri D, Huemer GM, Nicoli F, Larcher L, Dashti T, Grassetti L, Li Q, Zhang Y, Spinelli G, Agostini T. Indications, outcomes, and complications of pedicled propeller perforator flaps for upper body defects: A systematic review. Arch Plast Surg. 2013;40(1):44–50.
17. Georgescu AV. Propeller perforator flaps in distal lower leg: Evolution and clinical applications. Arch Plast Surg. 2012;39(2):94–105.
18. Rad AN, Christy MR, Rodriguez ED, Brazio P, Rosson GD. The anterior tibialis artery perforator (ATAP) flap for traumatic knee and patella defects: Clinical cases and anatomic study. Ann Plast Surg. 2010;64(2):210–216.
19. Moscatiello F, Masia J, Carrera A, Clavero JA, Larra~ naga JR, Pons G. The ‘propeller’ distal anteromedial thigh perforator flap. Anatomic study and clinical applications. J Plast Reconstr Aesthet Surg. 2007;60(12):1323–30
20. Hupkens P1, Van Loon B, Lauret GJ, Kooloos JG, Vehof JW, Hartman EH, Spauwen PH. Anteromedial thigh flaps: an anatomical study to localize and classify anteromedial thigh perforators. Microsurgery. 2010;30(1):43-9.
21. Moscatiello F1, Masià J, Carrera A, Clavero JA, Larrañaga JR, Pons GThe 'propeller' distal anteromedial thigh perforator flap. Anatomic study and clinical applications. .J Plast Reconstr Aesthet Surg. 2007;60(12):1323-30.
22. Akhtar MS1, Khan AH1, Khurram MF1, Ahmad I1. Inferiorly based thigh flap for reconstruction of defects around the knee joint. Indian J Plast Surg. 2014;47(2):221-6.
23. Perrault D, Manrique OJ, Lee G, Carre AL, Oakes DA, Wong AK. Complex Reconstruction of the Knee with a Free Vertical Rectus Abdominis Flap after Periprosthetic Soft Tissue Necrosis. Cureus. 2019;11(1):3969.
24. Alshomer F, Alhujayri A, Althubaiti G. Pedicled Peroneal Artery Perforator Flap for Knee Defect Reconstruction: Case Presentation and Literature Discussion. Plast Reconstr Surg Glob Open. 2018;6(11):2034.