Fowler David
Western Veterinary Specialist Centre, 1635 17th Avenue SW, Calgary, Alberta T2T 0E5, Canada.
Vet Clin North Am Small Anim Pract. 2006 Jul;36(4):819-45. doi: 10.1016/j.cvsm.2006.02.004.
Distal limb reconstruction is complicated by the paucity of local tissues and the frequent association of orthopedic injury with cutaneous loss. Second-intention healing or skin stretching techniques are used for wounds involving less than a 30% circumference of the limb. Skin grafts are recommended for reconstruction of larger superficial wounds after establishing a bed of granulation tissue or for immediate reconstruction of clean wounds overlying healthy muscle. Wounds complicated by orthopedic injury benefit from early reconstruction using vascularized tis-sue. Weight-bearing surface reconstruction and management of partial amputation injuries are functionally difficult because of the environmental stress placed on the paw pads. Paw pad grafts, paw pad transposition techniques, centralization of digits, and microvascular free tissue trans-fer of paw pads can be considered for weight-bearing surface reconstruction. Definitive guidelines describing when each of these techniques should be used have not been established.
远端肢体重建因局部组织匮乏以及骨科损伤常伴有皮肤缺损而变得复杂。二期愈合或皮肤拉伸技术用于肢体周径损伤小于30%的伤口。对于较大的浅表伤口，在建立肉芽组织床后建议进行植皮，或对覆盖健康肌肉的清洁伤口进行即刻重建。伴有骨科损伤的伤口通过使用带血管组织进行早期重建会受益。由于爪垫承受的环境压力，负重面重建和部分截肢损伤的处理在功能上具有挑战性。对于负重面重建可考虑采用爪垫移植、爪垫移位技术、手指中心化以及爪垫的微血管游离组织移植。尚未建立描述何时应使用这些技术的明确指南。
