Hootnick D R, Packard D S, Levinsohn E M, Crider R J
Department of Orthopedic Surgery, State University of New York Health Science Center, Syracuse 13210, USA.
J Pediatr Orthop B. 1999 Jul;8(3):187-93. doi: 10.1097/01202412-199907000-00009.
This study describes postoperative necrosis of the hallux and first ray in a child with clubfoot. Arteriography performed on this child's lower limbs demonstrated, in the operated leg, hypoplasia of both the anterior and posterior tibial arteries and failure of the dorsalis pedis artery to traverse the tarsus and complete the deep plantar arch. Previously, congenital vascular deficiency was suggested to predispose such operated limbs to necrosis. These findings confirm the association between vascular deficiency and necrosis. In this present study, the metabolic demands of wound healing were sufficient in a limb with vascular deficiency to cause localized distal hypoperfusion leading to cyanosis and necrosis of the hallux and medial foot.
本研究描述了一名患有马蹄内翻足儿童术后拇趾及第一跖骨的坏死情况。对该患儿下肢进行的动脉造影显示，在手术侧下肢，胫前动脉和胫后动脉均发育不全，足背动脉未能穿过跗骨并完成足底深弓。此前，有研究认为先天性血管缺陷会使此类手术肢体易于发生坏死。这些发现证实了血管缺陷与坏死之间的关联。在本研究中，对于存在血管缺陷的肢体，伤口愈合的代谢需求足以导致局部远端灌注不足，进而引起拇趾和足内侧发绀及坏死。
