Department of Plastic Surgery, Georgetown University Hospital, Washington, DC 20007, USA.
J Reconstr Microsurg. 2009 Nov;25(8):475-8. doi: 10.1055/s-0029-1225536. Epub 2009 Jul 10.
Many patients with complex wounds on single-vessel lower extremities undergo amputation. Limb salvage using microvascular reconstructive techniques is an alternative in these patients that can preserve ambulatory status, but data focused on reconstruction in the single vessel population have been limited. A retrospective review of all microvascular lower-extremity reconstructions from August 2003 to December 2008 was performed. Forty-two patients were identified, of which 10 were found to have a complex wound and single-vessel perfusion to the affected extremity. Patient charts were reviewed for age, sex, medical comorbidities, mechanism of injury (traumatic versus nontraumatic), wound location, flap type, complications, flap outcome, and limb salvage outcome. All 10 flaps were successful (100%), and long-term limb salvage was 90%. Mean follow-up was 20.4 months. There were two complications, a hematoma and a case of flap success followed by reactivation of osteomyelitis 3 months after the free flap procedure resulting in below-knee amputation. The ultimate goal of limb salvage is to maximize limb length in an effort to prevent an increase in the energy of ambulation. Using microvascular reconstructive techniques, it can be performed successfully and with the majority of patients regaining an ambulatory status.
许多患有单一肢体复杂创伤的患者需要截肢。在这些患者中，使用显微血管重建技术进行保肢是一种替代方案，可以保留步行能力，但专注于单一血管人群重建的数据一直有限。对 2003 年 8 月至 2008 年 12 月期间所有下肢显微血管重建的回顾性研究。确定了 42 名患者，其中 10 名患者的受影响肢体存在复杂创伤和单一血管灌注。回顾患者的病历，了解年龄、性别、合并症、创伤机制（创伤性与非创伤性）、创伤部位、皮瓣类型、并发症、皮瓣结果和肢体保留结果。所有 10 个皮瓣均成功（100%），长期肢体保留率为 90%。平均随访时间为 20.4 个月。有两个并发症，一个血肿和一个皮瓣成功病例，随后在游离皮瓣手术后 3 个月出现骨髓炎复发，导致膝下截肢。保肢的最终目标是最大限度地延长肢体长度，以防止步行能量增加。使用显微血管重建技术，可以成功地进行保肢手术，大多数患者恢复步行能力。
