PDF(Pubmed)
Abstract：
This case series describes the clinical course and reconstructive methods utilized for patients with diabetes and significant gangrene and necrosis following coronavirus disease 2019 (COVID-19) infection. COVID-19 produces mainly respiratory symptoms but has a variety of atypical presentations and sequelae. Serious complications are increased in patients with underlying medical conditions such as diabetes mellitus. By generating a prothrombotic milieu, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) increases the risk for arterial and venous thromboses. Inflammatory damage and micro-thromboses are thought to contribute to acro-ischemia, colloquially known as \'COVID toes,\' which presents cutaneously as chilblain-like lesions. Necrosis can be severe and devastating, often resulting in major amputation. Two exemplary case reports are presented herein: first, a 57-year-old female presented for vascular evaluation with pedal gangrene to the midfoot one month after developing painful discoloration in her right toe. After angioplasty restored pedal blood flow, she received a transmetatarsal amputation (TMA) with a local tissue flap. Second, a 41-year-old female presented for vascular evaluation with extensive pedal gangrene three months after hospitalization for COVID-19. After arteriotomy improved pedal blood flow, she underwent a Lisfranc amputation followed by superficial circumflex iliac artery perforator (SCIP) flap reconstruction. Sufficient evidence suggests that COVID-19 impairs microcirculatory function and can be especially detrimental in diabetic patients. Reconstructive techniques in patients with severe gangrene with COVID toes help patients regain functionality.
摘要：
本病例系列描述了2019年冠状病毒病（COVID-19）感染后糖尿病和严重坏疽和坏死患者的临床病程和重建方法。COVID-19主要产生呼吸道症状，但有多种非典型表现和后遗症。患有基础医疗状况如糖尿病的患者的严重并发症增加。通过产生血栓前环境，严重急性呼吸综合征冠状病毒2(SARS-CoV-2)增加动脉和静脉血栓形成的风险.炎症损伤和微血栓形成被认为有助于关节缺血，俗称“COVID脚趾”，皮肤表现为冻疮样病变。坏死可能是严重和毁灭性的，经常导致截肢。本文提供了两个示例性病例报告：首先，一名57岁的女性在右脚趾出现疼痛性变色一个月后，出现脚踏板坏疽，进行血管评估。血管成形术恢复踏板血流后，她接受了带局部组织瓣的经跖骨截肢术（TMA）。第二,一名41岁女性因COVID-19住院3个月后接受血管评估，患有广泛的踏板坏疽。动脉切开术后改善了踏板血流，她接受了Lisfranc截肢术,随后进行了旋髂浅动脉穿支(SCIP)皮瓣重建.充分的证据表明，COVID-19损害微循环功能，对糖尿病患者尤其有害。COVID脚趾严重坏疽患者的重建技术帮助患者恢复功能。
