Braun C, Olinger A
Department of Trauma Surgery, University of Saarland Medical School, Homburg/Saar, Germany.
J Reconstr Microsurg. 1992 May;8(3):185-92; discussion 193-4. doi: 10.1055/s-2007-1006699.
The replantation of large limb segments presents two major problems: first, a general danger to survival because of major accompanying injuries and additional ischemia-reperfusion injury; second, local soft-tissue damage at the amputation site. Successful replantation can be compromised by infection, vessel thrombosis, and disturbed bone healing. Possible risk reduction may be accomplished by the concept of a two-staged replantation. A brief primary emergency procedure involving bone resection, osteosynthesis, and revascularization (with the goal of limb survival) is followed by a second procedure within 72 hr after trauma, for final debridement, completing the osteosynthesis, nerve and tendon suturing, and soft-tissue coverage by free flaps. The advantages of the double procedure are demonstrated in 27 patients by comparison of two treatment groups. Group I comprised 15 patients with definitive primary care. In Group 2 (n = 12), the two-stage operation was performed. The second group showed a shorter duration of overall treatment, reduction of blood loss, and fewer infections.
其一，因严重的伴随损伤和额外的缺血再灌注损伤而对存活构成的总体危险；其二，截肢部位的局部软组织损伤。感染、血管血栓形成和骨愈合紊乱会影响再植的成功。通过两阶段再植的概念可能实现风险降低。一个简短的初步紧急手术包括骨切除、骨固定和血管再通（目的是保住肢体），之后在创伤后72小时内进行第二个手术，进行最终清创、完成骨固定、神经和肌腱缝合以及用游离皮瓣覆盖软组织。通过比较两个治疗组，在27例患者中证明了这种双重手术的优势。第一组包括15例接受确定性初级治疗的患者。第二组（n = 12）进行了两阶段手术。第二组显示总体治疗时间更短、失血量减少且感染更少。
