Cormier J M, Firouzabadie H, Gigou F
J Chir (Paris). 1975 May-Jun;109(5-6):575-90.
Gangrene is the usual reason for admission to a surgical unit in elderly patients with peripheral vascular disease. It is often the first sign of arterial disease occurring in a foot with satisfactory skin and may be triggered off by trauma or infection. Obstruction at various levels of the profunda femoris artery, of the main leg arteries with calcification of the media, are the usual characteristics, whether the patient is diabetic or not. This explains why reconstructive vascular surgery is rarely possible but this, nevertheless, remains the best chance for obtaining healing of trophic disorders with limited removal of the toes. No failure was observed in cases of axillo-femoral or femoro-femoral by-pass. But, as in diabetics, one may, in elderly patients with gangrene, attempt to conserve weight-bearing areas thanks to medical treatment in association in some cases with lumbar sympathectomy when the patient's general condition makes this possible. The mortality is low when patients are selected for operation and depending on the surgical technique adopted, e.g. sub-cutaneous by-pass or surgery of the origin of the profunda femoris. The mortality is less than 7 p. 100 during the first month (one death in 31 vascular operations, one death in 40 sympathectomies), but the mortality during the first 6 months exceeds 20 p. 100 due to cardiac, or cerebral complications or urinary infection. The prevention of digestive symptoms, nutritional, renal or urinary complications, and electrolyte disturbances is essential together with physiotherapy and reduction in time spent in hospital, for example, the patient may be sent home and treated by the district nurse. 135 patients with arteritis, including 48 diabetics, aged over 70 years, admitted to hospital in 1971 at the Saint-Joseph hospital, illustrate these findings. 109 patients with 114 diseased limbs, had gangrene or ischemic ulcer. Out of 80 survivors, beyond 6 months, i.e. 84 limbs, in 75 cases the weight bearing areas were preserved, in 9 cases amputation was necessary but in 8 of these it was possible to carry out amputation below the knee and walking was possible. These functional results justify attempts to maintain weight bearing areas or, at least, the knee, whatever the duration of healing or amputation of a toe or of the metatarsus; in Syme's amputation of the leg, healing requires 2 to 4 months.
坏疽是患有外周血管疾病的老年患者入住外科病房的常见原因。它通常是足部出现令人满意的皮肤时动脉疾病的首个迹象，可能由创伤或感染引发。无论患者是否患有糖尿病，股深动脉各级以及腿部主要动脉伴有中层钙化的阻塞是常见特征。这就解释了为什么重建性血管手术很少可行，但尽管如此，这仍是在有限切除脚趾的情况下实现营养障碍愈合的最佳机会。腋-股或股-股旁路手术未观察到失败病例。但是，与糖尿病患者一样，对于患有坏疽的老年患者，在患者一般状况允许的情况下，有时可借助药物治疗并联合腰交感神经切除术来尝试保留负重区域。若患者被选作手术对象并取决于所采用的手术技术，如皮下旁路手术或股深动脉起始部手术，死亡率较低。第一个月内死亡率低于7%（31例血管手术中有1例死亡，40例交感神经切除术中1例死亡），但前6个月内由于心脏、脑部并发症或泌尿系统感染，死亡率超过20%。预防消化症状、营养、肾脏或泌尿系统并发症以及电解质紊乱至关重要，同时还需进行物理治疗并缩短住院时间，例如，可将患者送回家由社区护士进行治疗。1971年入住圣约瑟夫医院的135例年龄超过70岁的动脉炎患者（包括48例糖尿病患者）说明了这些发现。109例患者有114条患病肢体，患有坏疽或缺血性溃疡。在80例存活超过6个月的患者中，即84条肢体，75例保留了负重区域，9例需要截肢，但其中8例可行膝下截肢且患者仍可行走。这些功能结果证明，无论脚趾或跖骨愈合或截肢的时间长短，都应尝试保留负重区域或至少保留膝盖；在Syme小腿截肢术中，愈合需要2至4个月。
