Ruckley C V, Stonebridge P A, Prescott R J
University Department of Surgery, Royal Infirmary, Edinburgh, Scotland.
J Vasc Surg. 1991 Mar;13(3):423-7. doi: 10.1067/mva.1991.25644.
A multicenter trial of alternative techniques for below-knee amputation is described in which surgeons in 11 centers randomized 191 patients with end-stage occlusive vascular disease to two different methods of stump construction. The skewflap technique was performed in 98 and the long posterior flap was performed in 93. The two groups were well matched in respect to age, sex, smoking, diabetes, and indications for amputation. Early outcome was compared in terms of 30-day mortality rate: skew 11 (11%) deaths versus long posterior flap 16 (17%); the state of the wound at 1 week (primary healing 60% in both groups); the need for surgical revision at the same level 7 (7%) versus 7 (8%), and revision to a higher level 10 (10%) versus 7 (8%). Follow-up information at 6 months was available from records or by mailed questionnaire in 188 (98%) at 6 months, 20 died during that interval. It showed that a prosthetic limb was fitted to 64 (84%) of skew flaps and 50 (77%) of long posterior flaps. Walking, alone or with support, was achieved in 59 (78%) and 46 (71%), respectively. None of these differences reached statistical significance. It is concluded that the skew flap is just as effective as the long posterior flap and is an excellent option for below-knee amputation.
本文描述了一项关于膝下截肢替代技术的多中心试验，11个中心的外科医生将191例终末期闭塞性血管疾病患者随机分为两种不同的残端构建方法。98例患者采用斜皮瓣技术，93例患者采用长后皮瓣技术。两组在年龄、性别、吸烟、糖尿病和截肢指征方面匹配良好。比较了早期结果，包括30天死亡率：斜皮瓣组11例（11%）死亡，长后皮瓣组16例（17%）；1周时伤口状况（两组一期愈合率均为60%）；同一水平再次手术的需求，斜皮瓣组7例（7%），长后皮瓣组7例（8%），更高水平再次手术的需求，斜皮瓣组10例（10%），长后皮瓣组7例（8%）。6个月时的随访信息可从记录中获取，或通过邮寄问卷获得，188例（98%）患者有随访信息，在此期间20例死亡。结果显示，64例（84%）斜皮瓣患者和50例（77%）长后皮瓣患者安装了假肢。分别有59例（78%）和46例（71%）患者能够独立行走或在辅助下行走。这些差异均未达到统计学意义。结论是，斜皮瓣与长后皮瓣同样有效，是膝下截肢的一个极佳选择。
