Institute of Reconstructive Plastic Surgery, New York University Langone Medical Center, New York, NY 10016, USA.
J Am Coll Surg. 2010 Jan;210(1):66-72. doi: 10.1016/j.jamcollsurg.2009.09.040. Epub 2009 Nov 18.
Management of severe traumatic lower extremity injuries remains a considerable challenge. Free tissue transfer is now a standard part of reconstruction for Gustilo IIIB and IIIC injuries. There is limited information on arterial injury patterns in this population. We undertook a review of our experience to gain insight on vascular injury patterns and surgical outcomes.
A 26-year retrospective analysis was performed of all lower extremity Gustilo IIIB and IIIC injuries requiring microvascular reconstruction at New York University Medical Center. Patient demographics, Gustilo classification, angiographic findings (conventional/computed tomographic angiography/magnetic resonance angiography), recipient vessels, elapsed time from injury, flap choices, and outcomes were examined.
Two hundred twenty-two free flaps on 191 patients were performed from September 1982 until March 2008. There were 151 males and 40 females ranging in age from 4 to 83 years (median age 33 years). Patients sustained either Gustilo IIIB (170 patients) or IIIC (21 patients) open fractures. One hundred fifty-four patients had angiograms (78.2% IIIB, 100% IIIC). Sixty-six (42.9%) had normal 3-vessel runoff and 88 (57.1%) were abnormal. Sixty-one patients (31.9%) had anterior tibial injuries, 17 patients (8.9%) had posterior tibial injuries, and 30 (15.7%) had peroneal injuries. Sixty-three complications occurred (11 early thrombosis, 33 requiring secondary procedures, and 10 requiring amputation).
Angiography of severe lower extremity injuries requiring free flap reconstruction usually revealed arterial injury and is generally indicated. In our experience, the anterior tibial artery is most commonly injured and the posterior tibial artery is most likely to be spared and used as a recipient.
严重创伤性下肢损伤的处理仍然是一个重大挑战。游离组织移植现在是 Gustilo IIIB 和 IIIC 损伤重建的标准组成部分。关于该人群的动脉损伤模式，信息有限。我们对我们的经验进行了回顾，以深入了解血管损伤模式和手术结果。
对纽约大学医疗中心需要微血管重建的所有 Gustilo IIIB 和 IIIC 下肢损伤患者进行了 26 年的回顾性分析。检查了患者的人口统计学特征、Gustilo 分类、血管造影结果（常规/计算机断层血管造影/磁共振血管造影）、受区血管、受伤至手术的时间、皮瓣选择和结果。
1982 年 9 月至 2008 年 3 月期间，对 191 名患者的 222 个游离皮瓣进行了手术。患者为 151 名男性和 40 名女性，年龄 4 至 83 岁（中位数年龄 33 岁）。患者均为 Gustilo IIIB（170 例）或 IIIC（21 例）开放性骨折。154 例患者行血管造影（78.2% IIIB，100% IIIC）。66 例（42.9%）有正常的 3 支血管流出，88 例（57.1%）有异常。61 例（31.9%）患者胫骨前动脉损伤，17 例（8.9%）患者胫骨后动脉损伤，30 例（15.7%）患者腓动脉损伤。63 例患者发生并发症（11 例早期血栓形成，33 例需要二次手术，10 例需要截肢）。
游离皮瓣重建严重下肢损伤需要血管造影，通常显示动脉损伤，一般需要进行血管造影。根据我们的经验，胫骨前动脉最常受损，而胫骨后动脉最有可能幸免并用作受区血管。
