Abstract：
BACKGROUND: Amputation of the wrist or distal forearm after high-energy trauma due to a crushing mechanism is associated with complex tissue defects, making repair, and reconstruction challenging. Given the difficulty of this type of salvage, patients unfortunately experience a high revision amputation rate. However, a higher quality of life has been reported in patients with successful reconstructions. Herein, we described a protocolized approach for revascularization and reconstruction for functional hand salvage after traumatic amputation from a crushing mechanism using an anterolateral thigh flap (ALT).
METHODS: A retrospective review was performed between October 2016 and October 2023 for all patients who underwent single-stage emergent debridement, revascularization, and soft tissue coverage using the ALT after amputation at the level of the wrist or distal forearm secondary to high-energy crush injury. Charts were reviewed for the preoperative Mangled Extremity Salvage Score, intraoperative details including what structures were injured and the reconstructive method performed, and postoperative data such as follow-up duration, outcomes, and complications.
RESULTS: Eleven patients met the inclusion criteria with an average age of 35.5 (21-49) years old. The average size of the skin soft tissue defects was 17.3 × 8 cm (range, length: 13-25 cm, width: 6-13 cm), and all cases had associated injury to the underlying bone, nerves, and blood vessels. The average size of the ALT flap used for reconstruction was 19.2 × 9.8 cm (range, length: 14-27 cm, width: 7-15 cm). All patients had survival of the replanted limb. One patient experienced partial flap necrosis that required secondary debridement and skin graft. Nine patients healed without requiring any additional debridement procedures. Patient follow-up averaged 24.6 (12-38) months. All patients achieved satisfactory functional recovery with Grade II to III of Chen\'s criteria.
CONCLUSIONS: For patients with traumatic crush amputation to the wrist with surrounding soft tissue injury, thorough debridement, revascularization, and reconstruction of amputated limbs can be performed in a single stage using the ALT. A protocolized approach from two institutions is presented, demonstrating improved survival and reduced complications of the traumatized limb with improved long-term patient outcomes.
METHODS: A retrospective review was performed between October 2016 and October 2023 for all patients who underwent single-stage emergent debridement, revascularization, and soft tissue coverage using the ALT after amputation at the level of the wrist or distal forearm secondary to high-energy crush injury. Charts were reviewed for the preoperative Mangled Extremity Salvage Score, intraoperative details including what structures were injured and the reconstructive method performed, and postoperative data such as follow-up duration, outcomes, and complications.
RESULTS: Eleven patients met the inclusion criteria with an average age of 35.5 (21-49) years old. The average size of the skin soft tissue defects was 17.3 × 8 cm (range, length: 13-25 cm, width: 6-13 cm), and all cases had associated injury to the underlying bone, nerves, and blood vessels. The average size of the ALT flap used for reconstruction was 19.2 × 9.8 cm (range, length: 14-27 cm, width: 7-15 cm). All patients had survival of the replanted limb. One patient experienced partial flap necrosis that required secondary debridement and skin graft. Nine patients healed without requiring any additional debridement procedures. Patient follow-up averaged 24.6 (12-38) months. All patients achieved satisfactory functional recovery with Grade II to III of Chen\'s criteria.
CONCLUSIONS: For patients with traumatic crush amputation to the wrist with surrounding soft tissue injury, thorough debridement, revascularization, and reconstruction of amputated limbs can be performed in a single stage using the ALT. A protocolized approach from two institutions is presented, demonstrating improved survival and reduced complications of the traumatized limb with improved long-term patient outcomes.
摘要：
背景：由于挤压机制引起的高能创伤后腕部或前臂远端截肢与复杂的组织缺损有关，正在修理，重建具有挑战性。鉴于这种打捞的难度，不幸的是，患者的翻修截肢率高。然而,据报道,重建成功的患者的生活质量更高.在这里，我们描述了使用股前外侧皮瓣（ALT）从粉碎机制进行创伤性截肢后的功能性手抢救的血运重建和重建方法。
方法：2016年10月至2023年10月对所有接受单阶段紧急清创的患者进行了回顾性研究，血运重建,在高能量挤压伤继发的腕部或前臂远端截肢后，使用ALT覆盖软组织。检查术前复杂肢体挽救评分的图表，术中细节，包括哪些结构受伤和重建方法，和术后数据，如随访时间，结果，和并发症。
结果：11例患者符合纳入标准，平均年龄为35.5（21-49）岁。皮肤软组织缺损的平均大小为17.3×8cm（范围，长度:13-25厘米,宽度：6-13厘米），所有病例都对下面的骨骼有相关的损伤，神经,和血管。用于重建的ALT皮瓣的平均大小为19.2×9.8cm（范围，长度：14-27厘米，宽度：7-15厘米）。所有患者都有再植肢体的存活。一名患者出现部分皮瓣坏死，需要二次清创和皮肤移植。9例患者愈合，无需任何额外的清创程序。患者平均随访24.6(12-38)个月。所有患者均达到满意的功能恢复，符合陈氏标准的II至III级。
结论：对于外伤性腕部挤压截肢伴周围软组织损伤的患者，彻底清创,血运重建,截肢的重建可以使用ALT在一个阶段进行。提出了来自两个机构的协议化方法，证明创伤肢体的生存率提高，并发症减少，患者的长期预后得到改善。
方法：2016年10月至2023年10月对所有接受单阶段紧急清创的患者进行了回顾性研究，血运重建,在高能量挤压伤继发的腕部或前臂远端截肢后，使用ALT覆盖软组织。检查术前复杂肢体挽救评分的图表，术中细节，包括哪些结构受伤和重建方法，和术后数据，如随访时间，结果，和并发症。
结果：11例患者符合纳入标准，平均年龄为35.5（21-49）岁。皮肤软组织缺损的平均大小为17.3×8cm（范围，长度:13-25厘米,宽度：6-13厘米），所有病例都对下面的骨骼有相关的损伤，神经,和血管。用于重建的ALT皮瓣的平均大小为19.2×9.8cm（范围，长度：14-27厘米，宽度：7-15厘米）。所有患者都有再植肢体的存活。一名患者出现部分皮瓣坏死，需要二次清创和皮肤移植。9例患者愈合，无需任何额外的清创程序。患者平均随访24.6(12-38)个月。所有患者均达到满意的功能恢复，符合陈氏标准的II至III级。
结论：对于外伤性腕部挤压截肢伴周围软组织损伤的患者，彻底清创,血运重建,截肢的重建可以使用ALT在一个阶段进行。提出了来自两个机构的协议化方法，证明创伤肢体的生存率提高，并发症减少，患者的长期预后得到改善。
