PDF(Pubmed)
Abstract：
Patients with traumatic ischemic mangled extremities first undergo arterial reconstruction using autogenous vein grafts, followed by flap transplantation as a staged treatment for soft tissue reconstruction. This study aimed to report the outcomes of such a staged treatment. Thirteen patients underwent arterial reconstruction between February 2015 and April 2017 due to damage to the major blood vessels by the traumatic mangled extremities. Of them, 6 patients (5 males and 1 female with a mean age of 51 years, age range: 36-60 years) who underwent soft tissue reconstruction due to necrosis were retrospectively analyzed. The average Mangled Extremity Severity Score was 7.2 (range, 6-8). Injuries were found in the lower leg (4 cases), foot (1 case), and wrist and hand (1 case). Arterial reconstruction was performed using autologous venous grafts. The reconstructed arteries included the posterior tibial artery (3 cases), anterior tibial artery (1 case), dorsalis pedis artery (1 case), and radial artery (1 case). The blood circulation status of the reconstructed blood vessels was assessed using computed tomography angiography at an average of 5 weeks (range, 4-6 weeks) after arterial reconstruction. For some necrotic soft tissues, debridement and flap transplantation were performed an average of 7 weeks (range, 6-8 weeks) after arterial reconstruction. Soft tissue reconstruction was performed with an anterolateral thigh free flap in 4 cases, a local flap in 1 case, and a muscle flap in 1 case. In 5 out of 6 cases, blood circulation was maintained in the reconstructed blood vessels, resulting in the salvaging of the extremities. All the patients who underwent flap surgery survived. Notably, there were no special complications during a follow-up visit conducted at an average of 19 months post-reconstruction. To treat an ischemic mangled extremity, the limbs should first be salvaged with arterial reconstruction, followed by subsequent appropriate flap surgery when soft tissue necrosis occurs at the mangled site as a staged treatment.
摘要：
患有创伤性缺血性四肢骨折的患者首先使用自体静脉移植物进行动脉重建，其次是皮瓣移植作为软组织重建的分期治疗。本研究旨在报告这种分阶段治疗的结果。在2015年2月至2017年4月之间，有13例患者因创伤性四肢受损对主要血管造成损害而进行了动脉重建。其中,6例(男5例,女1例,平均年龄51岁,年龄范围：36-60岁）因坏死而接受软组织重建的患者进行回顾性分析。平均肢体严重程度评分为7.2(范围，6-8).小腿受伤（4例），脚（1例），手腕和手（1例）。使用自体静脉移植物进行动脉重建。重建的动脉包括胫骨后动脉（3例），胫骨前动脉(1例),足背动脉（1例），桡动脉（1例）。使用平均5周的计算机断层扫描血管造影评估重建血管的血液循环状态（范围，4-6周）动脉重建后。对于一些坏死的软组织，清创和皮瓣移植平均7周(范围，6-8周）动脉重建后。应用股前外侧游离皮瓣行软组织重建4例,1例局部皮瓣,1例肌肉皮瓣。在6个病例中，有5个，血液循环维持在重建的血管中，导致四肢的抢救。所有接受皮瓣手术的患者均存活。值得注意的是,在重建后平均19个月的随访中,没有出现特殊并发症.为了治疗肢体缺血，四肢首先要进行动脉重建,随后，当软组织坏死发生在受损部位时，进行适当的皮瓣手术，作为分期治疗。
