Shestak K C, Hendricks D L, Webster M W
University of Pittsburgh Department of Surgery, PA 15261.
J Vasc Surg. 1990 Nov;12(5):581-5. doi: 10.1067/mva.1990.23413.
We describe the treatment of a patient with end-stage peripheral vascular disease and ischemic ulceration of the lower extremity in whom an obliteration of the distal arterial bed precluded conventional arterial reconstruction. A nonhealing dorsal foot ulcer was debrided, and soft tissue reconstruction was accomplished by the free microsurgical transfer of a muscle flap to the distal lower extremity. Arterial inflow to this free flap was provided by a contralateral reversed saphenous vein graft from the proximal arterial tree of the leg. This procedure resulted in a healed wound, stable coverage, and limb salvage. The patient also noted complete relief of rest pain and improvement in his claudication symptoms. A follow-up arteriogram was done 2 months after surgery. Contrast injection directly into the artery of this flap showed new blood vessel growth from the muscle flap into the foot with anastomoses of these "new vessels" to the patient's native circulation. This experience suggests that limb salvage may be possible by the free microvascular transplantation of a muscle flap onto the limb in selected patients whose limbs are deemed "nonreconstructible."
我们描述了一名患有终末期外周血管疾病和下肢缺血性溃疡患者的治疗情况，该患者远端动脉床闭塞，无法进行传统的动脉重建。对一个不愈合的足背溃疡进行了清创，并通过将肌皮瓣游离显微移植至下肢远端完成了软组织重建。通过取自腿部近端动脉树的对侧隐静脉逆行移植为该游离皮瓣提供动脉血供。此手术使伤口愈合、覆盖稳定并挽救了肢体。患者还表示静息痛完全缓解，间歇性跛行症状有所改善。术后2个月进行了随访动脉造影。直接向该皮瓣的动脉内注入造影剂显示，有新的血管从肌皮瓣长入足部，这些“新血管”与患者的自身循环形成吻合。这一经验表明，对于某些被认为“无法重建”肢体的特定患者，通过将肌皮瓣游离微血管移植到肢体上，有可能挽救肢体。
