| Objectives We made the hemodynamic study and the associated measurement dataanalysis on the retrograde blood supply on the basis of the anatomical basis of descendingartery of knee. We made the descending artery of knee as Blood vessels carrying freetissue flap, After the repair of severe lower limb trauma large area of skin and soft tissuedefects, by observing the healing of flaps, observe the clinical treatment effect,study thefeasibility and practicality of clinical applications.Methods1Basic anatomy: the anatomical16sides by8patients (5males,10sides;3females,6sides) formalin-soaked fresh adult cadavers lower limbs were perfused throughthe femoral artery pressure was observed with red latex the following indicators:(1) Thestart of knee descending artery and its branches to take shape outside diameter vascularconditions;(2) Arterial anastomosis knee drop and knee peripheral arterial network;(3)The knee and the knee peripheral arterial descending artery anastomosis Network Beforethe vessel length.Measuring18cases of18patients with clinical operative side, the kneedescending artery retrograde arterial blood pressure measurement of arterial blood pressuremeasurements and blood translocation translocation after before. All measured data bySPSS19.0software for statistical analysis, the results of "mean±standard deviation," said.2Clinical application: from June2011to February2013, we applied retrograde kneedescending artery pedicle as an area to bring free tissue flap to repair large areas of thelower leg soft tissue defects in12cases. Knee descending artery carrying blood retrogradeanterolateral thigh flap8cases, knee descending artery carrying blood retrograde freelatissimus dorsi flap in4cases. To limb distal to the knee descending artery pedicle,retrograde and free anterolateral thigh flap or latissimus dorsi flap artery anastomosis, bythe great saphenous vein and the free zone anterolateral thigh flap or latissimus dorsi flapartery accompanying veins coincide. Anterolateral thigh flap or latissimus dorsi flapcarried in anterolateral cutaneous nerve or nerves affected area harness coincide saphenousnerve, sensory function protective flap reconstruction. By postoperative6months to2years of follow-up, survival was observed in patients with flap healing, postoperativecomplications, and functional recovery flap look and feel.Results1Basic anatomy: knee drop artery in the femoral artery accounted for93.7%,starting in the popliteal artery6.3%.There are two accompanying veins, similar toor slightly coarser than the outer diameter of the artery. Most medial branch that issuedshares,and then separate the articular branch,implicitly supporting two terminal branches.(1) Vastus medialis branch:75%from the bottom of the knee descending artery,25%fromthe bottom of the joint expenses, starting outside diameter(1.4±0.5)mm. Stem short, afterissuing into the intramuscular.(2) Articular branch: trunk issuing parts from the adductortubercle(7.2±0.6)cm, starting outside diameter(1.5±0.6)mm. trunk length(6.5±1.4)cm,walking down along the adductor tendon, including the separation of the adductor tubercleabove the final four relatively constant support, distributed along the adductor tubercle andthe medial femoral condyle, patellar shift behavior lower branch, respectively, with theknee, the medial branch artery and saphenous artery branch anastomosis to join thenetwork knee.(3) The implicit branch: the implicit branch of dry branches and joint kneedescending artery starting at95%, starting in the femoral artery directly accounted for3.5%,2.5%starting in the popliteal artery. Starting outside diameter (1.3±0.5)mm, thetrunk on the bottom of the femoral condyle(3.6±1.2)cm at by the trailing edge of the sartorius muscle light out, down and saphenous nerve and the great saphenous vein, alongissued sartorius muscular branches, cutaneous branches and periosteal branches, terminalbranches in the area near the surface of the skin goose foot and cutaneous branch of theposterior tibial artery and medial cutaneous branch of the artery coincide knee joint kneearteries form a network,and the inside of the knee and calf nutrition the inside of the upperskin. Knee and knee peripheral arterial descending artery coincide distance network islocated on the highest point of the proximal femoral condyle(4.6±1.5)cm. Descendingartery anastomosis knee vascular outer diameter(1.2±0.4)mm. Knee at the start descendingartery distal to the knee from its network of peripheral arterial anastomosis pointwas(6.23±2.30)cm. By precisely measuring the side of the group of patients livingspecimens of the proximal vascular translocation before antegrade arterial blood pressurevalues (82.5±16.2) mmHg, proximal vessel transposition after retrograde arterial bloodpressure values (52.3±12.3)mmHg. Arterial blood pressure vessels transposition centerafter a decrease of approximately25.3%compared to arterial blood pressure values beforeindexing. After the process of surgical procedures, descending artery ligation shares medialknee support retrograde translocation stocks are seen showing jet-like ejection proximalvessels.2Clinical Treatment:I incision healing,flap and skin graft donor site survived. Atthe last follow-up, Flap sensory recovery rate was41.67%excellent; flap protectivesensation recovery was91.67%; excellent appearance flap was75%; excellent flap donorsite appearance rate was83.33%.Conclusions1The descending genicular artery distal and lateral superior genicularartery, popliteal artery and arterial network of knee is constant, extensive anastomoses.2The descending genicular artery blood pressure after artery retrograde translocationdecreased about25.3%, can support tissue flap.3The descending genicular arteryretrograde blood carried free flap can be used as a clinical method of skin and soft tissuedefect of leg after severe trauma treatment. |
