Sunar H, Aygit C A, Afsar Y, Halici U, Duran E
Department of Cardiovascular Surgery, Trakya University Medical School, Edirne, Turkey.
Eur J Vasc Endovasc Surg. 2004 Feb;27(2):210-5. doi: 10.1016/j.ejvs.2003.09.013.
To review our experience with temporary arteriovenous (AV) fistula followed by free tissue transfer in the treatment of diabetic foot ulcers associated with peripheral arterial occlusion.
From July 1997 to July 2002, 15 lower extremities were operated in 14 patients. An AV loop with its apex below the medial malleolus was created between popliteal artery and saphenous system. Three weeks later, the loop was divided to provide an artery and a vein end. Foot defect was covered with latissimus dorsi muscle flap followed by split thickness skin grafting.
Fistulas were patent in 12 extremities. Free tissue transfer was performed in 13 extremities. Two free flaps failed. After patent temporary arteriovenous fistula, free tissue transfer was successful in 11 of 12 extremities. One patient was amputated below knee due to ongoing infection despite successful free tissue transfer. Early mortality rate was 7%. Limb salvage was achieved in 11 of 13 extremities that staged operation was performed. Overall extremity loss was four of 15 lower extremities in 14 patients. Overall mortality was 21% for mean 20 follow-up period.
Temporary AV fistula and free flap may provide stable wound coverage and high rate of limb salvage in treatment of diabetic foot ulcers with large tissue loss.
回顾我们采用临时动静脉（AV）瘘并结合游离组织移植治疗伴有外周动脉闭塞的糖尿病足溃疡的经验。
1997年7月至2002年7月，14例患者的15条下肢接受了手术。在腘动脉和大隐静脉系统之间建立一个顶端位于内踝下方的AV袢。三周后，将该袢切断以提供一条动脉端和一条静脉端。足部缺损先用背阔肌肌皮瓣覆盖，然后进行刃厚皮片移植。
12条肢体的瘘保持通畅。13条肢体进行了游离组织移植。2个游离皮瓣失败。在临时动静脉瘘通畅后，12条肢体中的11条游离组织移植成功。1例患者尽管游离组织移植成功，但因持续感染而在膝下截肢。早期死亡率为7%。在接受分期手术的13条肢体中，11条实现了保肢。14例患者的15条下肢中共有4条肢体缺失。平均20个月的随访期内总死亡率为21%。
临时AV瘘和游离皮瓣可为伴有大面积组织缺损的糖尿病足溃疡提供稳定的创面覆盖和较高的保肢率。
