Objective To investigate the characteristics of blood supply of popliteal fossa middle artery pedicled flaps and the feasibility of reconstruction of postburn popliteal fossa contractures using the flaps in children. Methods Between January 2008 and October 2010, 6 cases of postburn popliteal fossa contractures were recontructed using popliteal fossa middle artery pedicled flaps. Of them, 2 were boys and 4 were girls, aged from 2 years and 2 months to10 years. All burns were caused by hot water. The wound ranged from 5 cm × 4 cm to 10 cm × 8 cm after scar relaxation. The size of the flap ranged from 6 cm × 4 cm to 11 cm × 9 cm. Donor sites were covered with split-thickness skin graft in 5 cases, and sutured directly in 1 case. Results All the flaps and the skingraft survived; no vascular crisis or flap necrosis occurred. All incisions at donors and wounds healed by first intention. All patients were followed up 12-24 months. The color, texture, and appearance of the flaps were good. Hyperplastic scar was found at incision of popliteal fossa in 1 case at 6 months after operation; the range of motion (ROM) of the knee joint was 0-175°, and no obvious change was observed at 15 months after operation. The others had no functional disturbance of the knee joints or claudication; the ROM of the knee joint was 0-180°. Conclusion The popliteal fossa middle artery pedicled flap has reliable blood supply, simple operative procedure, and good results in reconstruction of popliteal fossa contracture.
Objective To provide the anatomical basis for posterior femoral neurocutaneous vascular flap pedicled with direct popliteal artery perforator. Methods A total of 30 embalmed lower limbs of adult cadavers perfused with red latex were dissected and measured to observe the course and distribution of posterior femoral cutaneous nerve (PFCN), and the anastomoses between direct popliteal artery perforator and nutrient vessels of PFCN. Mimic operation was performed on 1 side of fresh specimen. Results PFCN started from the midpoint of the inferior gluteus maximus edge, and went down along the middle line of posterior thigh region, and the final trunk of PFCN accompanied with small saphenous vein down to the middle line of lower leg. The diameters of PFCN was (3.0 ± 0.6) mm at the inferior gluteus maximus edge, and was (2.0 ± 0.7) mm at the superior fossa poplitea. The nutrient vessels of PFCN were multi-segmental and polyphyletic. The direct popliteal artery perforator which started from popliteal artery directly was constant pierced into deep fascia about 7-11 cm above the knee joint, and its original diameter was (0.8 ± 0.2) mm. The direct popliteal artery perforator had 1-2 accompanying veins, and this perforator artery was the main nutrient vessel of the inferior segment of PFCN. The direct popliteal artery perforator gave off 5-8 small vessels which anastomosed with the 1st-3rd perforator of deep femoral artery, the obturator artery perforator, and the lateral femoral circumflex artery perforators. Then these nutrient vessels formed vascular plexus along PFCN in the middle line of posterior region of thigh. Mimic operation showed that the posterior femoral neurocutaneous vascular flap pedicled with direct poplitea artery perforator could be formed successfully. Conclusion The posterior femoral neurocutaneous vascular flap pedicled with direct popliteal artery perforator has constant blood supply and can be easily formed to repair defects around knee joint.
ObjectiveTo investigate the methods and the effectiveness of arthroscopic treatment combined with repair of the cyst wall using the tendon flap of medial head of gastrocnemius muscle after resection of popliteal cyst. MethodsA retrospective analysis was made on the clinical data of 140 patients with popliteal cyst between August 2009 and June 2014, including 44 males and 96 females with a mean age of 54.68 years (range, 14-80 years). The median course of symptoms was 31 months (range, 20 days to 30 years). According to Rauschning and Lindgren criteria for popliteal cyst grade, 4 cases were rated as grade Ⅰ, 44 cases as grade Ⅱ, and 92 cases as grade Ⅲ. The preoperative Lysholm knee score was 68.99±8.23. Firstly, cyst was resected, then the hernia sac of joint capsule was repaired with the tendon flap of medial head of gastrocnemius muscle, and finally a knee arthroscopy was used for the diagnosis and treatment of intra-articular lesions. ResultsNo complication of nerve or blood vessel injury, infection, or necrosis occurred. The mean follow-up was 26 months (range, 6-64 months). During follow-up, 1 case (0.71%) had cyst recurrence. According to Rauschning and Lindgren criteria for popliteal cyst grade, 37 cases were rated as grade 0, 92 cases as grade Ⅰ, 10 cases as grade Ⅱ, and 1 case as grade Ⅲ at 6 months after operation, showing significant difference when compared with preoperative one (Z=-14.303, P=0.000); the Lysholm knee score (85.51±9.23) was significantly higher than preoperative score (t=-15.798, P=0.000). ConclusionArthroscopic treatment combined with repair of the cyst wall with the tendon flap of medial head of gastrocnemius muscle after resection of popliteal cyst is a better way to avoid recurrence.
ObjectiveTo discuss the feasibility and effectiveness of link-pattern lateral popliteal artery perforator flap in repairing popliteal fossa scar contracture in children or teenagers. MethodsBetween January 2009 and January 2013, 12 patients with popliteal fossa scar were admitted. Of them, 7 cases were male and 5 cases were female, aged from 3 to 17 years (median, 12 years). The disease duration was from 6 months to 5 years (median, 3 years). Wound was repaired with link-pattern lateral popliteal artery perforator flap after remission of popliteal fossa scar. The wound ranged from 6 cm×4 cm to 10 cm×7 cm, and the flap size ranged from 7 cm×4 cm to 12 cm×9 cm. The flap was with lateral sural cutaneous nerve in 5 cases, and lateral sural cutaneous nerve was retained at the donor area of 7 cases. The donor site was repaired using split-thickness skin graft. ResultsAll pedicled flaps and skin graft survived smoothly after operation. The wound at donor site healed by first intention. All the cases were followed up 12-36 months, with an average of 18 months. The flaps had good color, texture, and shape; scar obviously became softened, without hyperplasia or ulceration. The patients were free from lameness with knee range of motion of 0-180°. The squatting function was normal. Grafting skin was smooth in the donor area of the calf, without depression or scar hyperplasia. The senses of posterior-inferior calf and lateral of foot decreased or disappeared in 5 cases of flaps with lateral sural cutaneous nerve; at 6 months after operation, two-point discrimination was 12-14 mm (mean, 13 mm). The posterior-inferior calf was numb and discomfort in 7 cases of flaps with retained lateral sural cutaneous nerve; but after 3-6 months, the sense was obviously recovered, with no sense loss; at 6 months after operation, two-point discrimination was 5-7 mm (mean, 6 mm). ConclusionLink-pattern lateral popliteal artery perforator flap has reliable blood supply and the operation was simple. The cutaneous nerve can be retained in donor area. It is an ideal method for repairing wound after remission of popliteal fossa scar in children or teenagers.
ObjectiveTo compare the short-term effectiveness between arthroscopic cystectomy and internal drainage combined with cystectomy in popliteal cyst.MethodsBetween March 2014 and March 2017, 56 patients with symptomatic popliteal cyst were enrolled in the study, randomized block design was used to divided the patients into trial group (arthroscopic cystectomy combined with internal drainage group, n=28) and control group (arthroscopic internal drainage group, n=28). Excluding those who had incomplete follow-up and received surgery for other diseases postoperatively, 26 patients in the experimental group and 27 patients in the control group were finally enrolled in the study. There was no significant difference in gender, age, side, course of disease, maximum diameter and grade of popliteal cyst, and associated diseases between two groups (P>0.05). The operation time, duration of popliteal ecchymosis and the middle back of calf tenderness were observed postoperatively. The circumference of calf at 1 day, 1 week, and 2 weeks after operation were measured and the differences were calculated with the measurement before operation. Lower extremity venous thrombosis was observed by color doppler ultrasonography at 1 week after operation. The effectiveness was evaluated by Rauschning and Lindgren grading criteria. And MRI was used to observe whether the popliteal cyst disappeared or decreased and measured its maximum diameter at 1 year after operation.ResultsPatients in both groups were followed up 12-14 months, with an average of 12.5 months. The operation time, duration of popliteal ecchymosis, and the middle back of calf tenderness of the trial group were all longer than those in the control group (P<0.05), the differences of circumference of calf at 1 day, 1 week, and 2 weeks after operation of the trial group were greater than those in the control group (P<0.05). Color doppler ultrasonography of the lower extremity at 1 week after operation found that the intermuscular venous thrombosis occurred in 2 cases of the trial group, while no lower extremity thrombosis was found in the control group; and the difference between two groups was not significant (P=0.236). According to the Rauschning and Lindgren grading criteria, there were 16 cases of grade 0, 6 cases of grade 1, and 4 cases of grade 2 in the trial group, and 17 cases of grade 0, 4 cases of grade 1, and 6 cases of grade 2 in the control group at 1 year after operation. There was no significant difference between 2 groups (Z=–1.872, P=0.078). Nine cases (34.62%) of the trial group and 13 cases (48.15%) of the control group still have residual cysts by MRI, the maximum diameter of which was less than 2 cm. The cysts disappeared in the remaining patients in both groups, and there was no recurrence during the follow-up. There was no significant difference in cyst residual rate between 2 groups (χ2=2.293, P=0.852).ConclusionCompared with arthroscopic internal drainage, the short-term effectiveness of the arthroscopic internal drainage combined with cystectomy had no significant improvement, and the operation time was prolonged, the postoperative complications were obviously increased.