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| 題 名 | Reverse Anterolateral Thigh Flap for Salvage of Infected and Exposed Knee Prostheses--A Case Report and Review of the Literature=以反向大腿前外側皮瓣治療人工關節暴露之膝部感染性傷口--病例報告及文獻回顧 |
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| 作 者 | 歐冠彣; 魏林瑰; 陳世宜; 陳錫根; | 書刊名 | 臺灣整形外科醫學會雜誌 |
| 卷 期 | 21:2 2012.06[民101.06] |
| 頁 次 | 頁158-163 |
| 分類號 | 416.413 |
| 關鍵詞 | 反向大腿前外側皮瓣; 膝部感染性傷口; Exposed knee prostheses; Reverse ALT flap; |
| 語 文 | 英文(English) |
| 中文摘要 | 背景:人工關節暴露之感染性傷口對接受過全膝關節置換的病人而言是非常嚴重的併發症,若沒有適當的抗生素治療、清創及循環良好的皮瓣覆蓋,會導致人工關節不得已的移除,甚至截肢的後果。然而,對膝蓋周圍的傷口重建,尤其是膝蓋上方的區域,卻一直沒有最理想的皮瓣可供使用。目的及目標:我們報告文獻上第一例使用反向大腿前外側皮瓣治療人工關節暴露之膝部感染性傷口的案例。病人及方法:一名57歲婦人在接受過右膝全膝關節置換手術後,傷口在術後三個月因一次跌倒裂開而形成慢性潰瘍,傷口持續有膿液引流且人工關節暴露長達三個月。病人住院後接受一個禮拜的抗生素治療及一次清創後,因傷口偏膝蓋上方,我們設計了反向大腿前外側皮瓣來覆蓋其傷口。結果:此皮瓣存活良好,且後續沒有關節感染的情況發生。在術後六個月的追蹤,病患對膝蓋的活動及外觀都滿意。結論:反向大腿前外側皮瓣非常適合覆蓋膝蓋上方的傷口,它提供大而薄的皮瓣尺寸,足夠長的血管而不用犧牲掉任何主要的肌肉或血管。以往我們認為分下這個皮瓣需要困難的技巧,因其血管分布較遠端、較細且多走在肌肉內,但隨著游離大腿前外側皮瓣用在重建頭頸癌的經驗越來越豐富,整形外科醫師對此皮瓣的血管分佈走向也十分熟悉,我們認為反向大腿前外側皮瓣可以更輕易且廣泛的運用在膝蓋周圍的傷口重建。 |
| 英文摘要 | Background: Exposed knee prosthesis with infection is a serious complication for patients receiving total knee replacement. There is no ideal soft tissue repair for the defects surrounding the knee, especially the upper knee region. Aim and objectives: We present the first case report of prosthesis-exposed knee with infection that was successfully reconstructed using a reversed anterolateral thigh (ALT) flap. Materials and Methods: A 57-year-old Taiwanese woman had a chronic wound on her right knee after total knee replacement surgery with prosthesis exposure for 3 months. Under antimicrobial therapy and after debridement, we designed a reversed ALT flap, 10 × 5 cm in size, to cover the defect. Results: The flap survived without complication, and no further prosthesis infection was noted in the postoperative course. In the 6-month follow-up, satisfactory knee motion and cosmetic results were achieved. Conclusion: The reversed ALT flap provides a large yet thin skin paddle and long pedicle without sacrificing dominant muscle and vessels. The main challenge of this procedure is the difficult harvesting technique. Upper knee defect reconstruction may become more popular with increase in knowledge of vascular anatomy and harvesting of free ALT flaps. |
本系統中英文摘要資訊取自各篇刊載內容。