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使用临时分流术作为一种挽救技术，用于在严重缺血期间需要通过血管移植修复的远端肢体截肢。

Use of a Temporary Shunt as a Salvage Technique for Distal Extremity Amputations Requiring Repair by Vessel Grafting during Critical Ischemia.

作者信息

Ince Bilsev, Dadaci Mehmet, Altuntas Zeynep

机构信息

Department of Plastic, Reconstructive, and Aesthetic Surgery, Necmettin Erbakan University, Meram Faculty of Medicine, Konya, Turkey.

出版信息

Arch Plast Surg. 2016 Nov;43(6):544-550. doi: 10.5999/aps.2016.43.6.544. Epub 2016 Nov 18.

DOI:10.5999/aps.2016.43.6.544
PMID:27896186
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5122544/
Abstract

BACKGROUND

Although the use of temporary shunts in proximal extremity amputations has been reported, no study has described the use of temporary shunts in distal extremity amputations that require vein grafting. Moreover, the total volume of blood loss when temporary shunts are used has not been reported. The aim of this study was to investigate the applicability of a temporary shunt for distal extremity amputations requiring repair by vessel grafting with an ischemia time of >6 hours. This study also aimed to determine the total volume of blood loss when temporary shunts were used.

METHODS

Patients who underwent distal major extremity replantation and/or revascularization with a vessel graft and who experienced ischemia for 6-8 hours between 2013 and 2014 were included in the study. A 6-Fr suction catheter was cut to 5 cm in length after the infusion of heparin, and secured with a 5-0 silk suture between the distal and the proximal ends of the artery. While bleeding continued, the bones were shortened and fixed. After the complete restoration of circulation, the arterial shunt created using the catheter was also repaired with a vein graft.

RESULTS

Six patients were included in this study. The mean duration of ischemia was 7.25 hours. The mean duration of suction catheter use during limb revascularization was 7 minutes. The mean transfusion volume was 7.5 units. No losses of the extremity were observed.

CONCLUSIONS

This procedure should be considered in distal extremity amputations requiring repair by vessel grafting during critical ischemia.

摘要

背景

虽然已有报道在近端肢体截肢术中使用临时分流管，但尚无研究描述在需要静脉移植的远端肢体截肢术中使用临时分流管的情况。此外，使用临时分流管时的总失血量尚未见报道。本研究的目的是探讨临时分流管在需要血管移植修复且缺血时间>6小时的远端肢体截肢术中的适用性。本研究还旨在确定使用临时分流管时的总失血量。

方法

纳入2013年至2014年间接受远端主要肢体再植和/或血管移植再血管化且缺血6 - 8小时的患者。在注入肝素后，将一根6Fr的吸引导管剪成5厘米长，并用5-0丝线固定在动脉的远端和近端之间。在出血持续的情况下，缩短并固定骨骼。在循环完全恢复后，使用导管建立的动脉分流管也用静脉移植进行修复。

结果

本研究纳入6例患者。平均缺血时间为7.25小时。肢体再血管化期间使用吸引导管的平均时间为7分钟。平均输血量为7.5单位。未观察到肢体丢失情况。

结论

在严重缺血期间需要血管移植修复的远端肢体截肢术中，应考虑采用此手术方法。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e1de/5122544/1e5ecd474075/aps-43-544-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e1de/5122544/36928b6ce8b6/aps-43-544-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e1de/5122544/6542484db4fb/aps-43-544-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e1de/5122544/c6982ddf4c13/aps-43-544-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e1de/5122544/1e5ecd474075/aps-43-544-g004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e1de/5122544/36928b6ce8b6/aps-43-544-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e1de/5122544/6542484db4fb/aps-43-544-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e1de/5122544/c6982ddf4c13/aps-43-544-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e1de/5122544/1e5ecd474075/aps-43-544-g004.jpg

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