下肢再植后的存活率和二期手术。

Survival and secondary surgery following lower extremity replantation.

机构信息

Hand and Upper Extremity Service, Hospital for Special Surgery, New York, New York.

Chang Gung Memorial Hospital, Chang Gung Medical College, Taipei, Taiwan.

出版信息

J Reconstr Microsurg. 2014 Jul;30(6):419-26. doi: 10.1055/s-0033-1363778. Epub 2014 Mar 28.

DOI:10.1055/s-0033-1363778

PMID:24683136

Abstract

BACKGROUND

The limited and inconsistent literature exists on survival and secondary surgery following lower limb replantation. The purpose of this study was to review our institutional experience in lower extremity replantation to quantify survival and characterize secondary surgeries.

METHODS

We performed a retrospective chart review of all lower extremity replantations at our institution between 2000 and 2012. The mean follow-up period was 2.6 years. Patient, injury, and surgical demographics as well as replantation survival, secondary surgical procedures, and complications were recorded.

RESULTS

A total of 22 lower extremity replantations were performed with 45% survival (n = 10). Secondary surgeries were common with an average of six per patient (range 2-11). Early secondary procedures included debridements (19 of 22 patients, 86%) and soft tissue coverage (15 of 22 patients, 68%). The average initial hospitalization was 45 days (range 19-90) and time to final secondary procedure in patients with surviving replantation was 1.5 years (range 18 d-3.5 y). Late secondary surgeries were aimed at either aesthetic or functional enhancement. The most common complication was deep infection in 18 of 22 patients (82%) and infection was felt to be the cause of replantation failure in all cases.

CONCLUSION

We found a modest survival following lower extremity replantation with several secondary surgeries in each case. Infection complicated the majority of cases and free tissue transfer was often required for wound coverage. Early secondary surgeries were aimed at debridement and soft tissue coverage while late secondary surgeries were aimed at either aesthetic or functional enhancement.

摘要

背景

下肢再植后的存活率和二次手术的相关文献有限且不一致。本研究旨在回顾本机构在下肢再植方面的经验，以量化存活率并分析二次手术的特点。

方法

我们对 2000 年至 2012 年期间在我院进行的所有下肢再植病例进行了回顾性图表分析。平均随访时间为 2.6 年。记录患者、损伤和手术人口统计学资料，以及再植存活率、二次手术程序和并发症。

结果

共进行了 22 例下肢再植手术，存活率为 45%（n=10）。二次手术很常见，平均每位患者进行 6 次手术（范围为 2-11 次）。早期的二次手术包括清创术（22 例患者中有 19 例，86%）和软组织覆盖术（22 例患者中有 15 例，68%）。平均初始住院时间为 45 天（范围为 19-90 天），存活再植患者最终进行二次手术的时间为 1.5 年（范围为 18 天至 3.5 年）。晚期二次手术旨在改善美观或功能。最常见的并发症是 22 例患者中的 18 例（82%）深部感染，所有病例均认为感染是再植失败的原因。