Donor-site morbidity of the pedicled rectus femoris muscle flap
Donor-site morbidity of the pedicled rectus femoris muscle flap
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DOI：
10.1097/01.prs.0000152422.64505.2a
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发表时间：
2005-03-01
影响因子：
3.6
通讯作者：
Fansa, H
中科院分区：
文献类型：
--
作者：
Daigeler, A;Dodic, T;Fansa, H
股直肌瓣以其可靠的解剖结构、易于获取和多功能性而闻名。作为带蒂或游离皮瓣，它用于覆盖软组织缺损和重建运动功能。虽然肌肉是非常可靠的，但它并没有得到很好的尊重，因为它假定供体部位的发病率，如膝关节伸展力减弱和膝关节活动范围减少。到目前为止，这些临床假设很少被量化的客观评分，有关的力量不足和功能或美学的结果。自1995年至2002年，作者应用带蒂股直肌肌瓣治疗24例。随访14例。随访时间范围为术后3至56个月。通过标准问卷对结果进行评估，其中评估了与行走距离相关的疼痛、主观虚弱感、感觉障碍、日常功能和美学方面。测量髋关节和膝关节的活动范围。为了客观地验证剩余股四头肌最大自主收缩力的降低，并检测真实肌肉容量和自主激活的差异，10例单侧股直肌皮瓣患者使用抽搐内插技术进行了测试。作者的患者评估剩余功能和大腿的美学结果至少令人满意。两名患者主诉大腿疼痛和无力。8名患者报告了外侧髌上区域的感觉迟钝。与健康腿相比，最大随意收缩和真实肌肉容量值分别降低了21.8%和18%。膝关节和髋关节的活动范围不受肌肉采集的影响。抽搐内插技术揭示了一个轻微的自愿激活赤字，可能是由抑制性调节脊髓。总之，股直肌皮瓣供区的发病率是明显的，但得到了很好的补偿。膝关节和髋关节的活动范围没有减少。患者对功能和美观结局的满意度很高。
The rectus femoris muscle flap is well known for its reliable anatomy, the ease with which it can be harvested, and its great versatility. As a pedicled or free flap, it is used to cover soft-tissue defects and to recreate motor function. Although the muscle is very reliable, it is not well respected because of its assumed donor-site morbidity, such as weakened knee extension force and decreased range of motion of the knee. To date, these clinical assumptions have only rarely been quantified in terms of objective scores, concerning force deficit and functional or aesthetic outcome. From 1995 to 2002, the authors treated 24 patients with pedicled rectus femoris muscle flaps. Fourteen patients were followed up. Follow-up time ranged from 3 to 56 months postoperatively. The results were evaluated by a standard questionnaire in which pain in relation to walking distance, subjective feeling of weakness, sensibility disorders, everyday function, and aesthetic aspects were assessed. Range of motion in the hip and the knee was measured. For objective verification of a decrease of maximal voluntary contraction force of the remaining quadriceps muscle and for detecting differences in true muscular capacity and voluntary activation, 10 patients with unilateral rectus femoris flaps were tested using the twitch interpolation technique. The authors' patients assessed the remaining function and the aesthetic result of the thigh as at least satisfactory. Two patients complained about pain and weakness in the thigh. Eight patients reported hypesthesia in the lateral suprapatellar region. The maximal voluntary contraction and true muscular capacity values were reduced by 21.8 percent and 18 percent, respectively, when compared with the healthy leg. The range of motion in the knee and hip was not influenced by muscle harvesting. The twitch interpolation technique revealed a mild voluntary activation deficit, probably caused by inhibitory regulation in the spinal cord. In conclusion, donor-site morbidity of the rectus femoris muscle flap is evident but well compensated. There is no decrease in active range of motion in the knee and hip. Patient satisfaction with the functional and aesthetic outcome was high.