Application Of Using Perforator Flaps Of Popliteal Intermediate Cutaneous Artery For Repairing Of Soft Tissue Defects Of Wound After Legs Amputation

Objective: To investigate Perforator Flaps of Popliteal Intermediate Cutaneous Artery(PICA) of the operation way and clinical efficiency about repair for soft tissue defects after legs amputation. Because of they injury seriously, the wound cannot be sutured with primary operation, and some tissue exposed like bone, internal fixatir and neurovascular ect. It causes osteomyelitis, amputation stump ulcer ect. If the patients don’t install prosthesis, the patient can not walk. To reserve functions of knee and recover functions of legs, it need design free flap and pedicel flap that repair amputation. Repairation of amputation is one of problems in Orthopaedic Trauma. The clinical doctors are working for finding and designing Pedicle flap. According to the size of the soft tissue defects on knee, taking the ascending branch of popliteal intermediate cutaneous artery as perforator combine with taking the medline of the posterior region of thigh as the axis were designed and obtained to repair the soft tissue defects of the knee after legs amputation. and follow up the healing of flap and the function of the affected knee joint in order to offer the theory basis and the new clinical treatment in the knee soft tissue defect.Methods: Two patients with the knee soft tissue defection after legs amputation were treatmented in our department from September 2013 to November 2014. They were both males, aged 33, 34years(average of 38 years old). The both injured area were right leg. They are accident and scar hyperplasia, the amputation plane of 2 cases were located between knee joint and 1/3 crus proximal, the defect size of soft tissue were 12cm×8cm and 14cm×6cm, the wound of the case has healed, but the scar of the wound hyperplasia obviously, and affect the active function of knee joint. The patient were treated with primary operation in the case cut out the scar. The other was chronic infection due to poor wound condition severe pollution after thorough debridement device adopts the Vacuum Sealing Drainage for 7 to 10 days, secondly operated by skin flap transplantation. After the debridement, the wound defect 18cm×10cm. According to the shape and size of soft tissue defects. The flaps were designed with the rotation point locating 30 mm proximal to the middle point between the medial and lateral condyles of the Femur was setted and the axis locate the medline of the posterior region of thigh and obtained to repair the soft tissue defects of the knee.the flap area depend on blood supply, they are 18cm×10cm and 20cm×12cm. when the flap width was above 8cm, the donor closed by packing pressure skin grafting in thick after reducing the wound through interrupted suture. The texture, survival size, and color of the flaps were checked up after the operation.Results: Two flaps survived totally. There was reruptureed and partial necrosis in 1 case, but the flap was satured directly in the end and healed well. The two flaps were stitched at 14 days. All cases were followed on postoperatively from 3 to 9 months. The flaps don’t rupture, except slight swell, the flaps color was close to nearby tissues,the flaps have good elasticity, tenacity. The active function of knee joint is good, the skin grafting have survival totally.Conclusions:1The wound with soft tissue defects(especially the soft around the knee joint was damaged) cannot be satured directly, sometimes we may be remove bone in order to close the wound, it may be breaks the knee joint, the function of legs was greatly restricted if placed prosthesis later, therefore the flap protection for the function of knee joint. the flap play an important in recovery of function of knee join.2The flap is from posterior region of thigh, the region is safe,the flap have advantaged of possessing abundance volume and messive concealment area and medium thickness, owning a small influence on the donor site for appearance and function.3The flap has advantages as follows: reliable blood supply, smiliar texture and thinness to the skin of hand,adjacent transfer, flap survival rate highly, short operative duration,minimal intra-operative blood loss, it is the best choice for repair of the soft tissue defects of knee and 1/3 crus proximal.