Department of Microsurgery, Orthopaedic Trauma and Hand Surgery, First Affiliated Hospital of Sun Yat-sen University, 58 Zhongshan Er Road, Guangzhou, China.
Department of Orthopaedic Surgery, New York University, New York, NY, USA.
Injury. 2019 Dec;50 Suppl 5:S111-S116. doi: 10.1016/j.injury.2019.10.060. Epub 2019 Nov 8.
Complex injuries of the extremity can be very challenging to treat. In the setting of soft tissue infection and vascular defect, arterial reconstructions are at high risk of failure. Historically, there have not been good options to successfully salvage limbs with these serious injuries. We describe our experience of utilizing a cross limb vessel transfer to salvage the limb.
Patients were identified retrospectively with complex vascular injuries of the extremity and wound infection, who were treated with a cross limb vessel transfer. Once the infection has successfully been cleared, flow-through flap transfer was performed for definitive reconstruction of the arterial injury. Data collated included patient demographics, injury and operation details, and post-operative outcomes including blood supply of the limb, wound infection and complications.
Between April 2014 and January 2017, 3 patients with an average age of 21 years (range, 16-29) were admitted. The median length of hospital stay was 62 days (range, 26-122). The average number of operation was 7.3 times (range, 6-10). Two patients' upper limb had survived with limited movement, relatively minor donor site morbidity and confirmed flow through the vessel reconstruction using CTA, while one patient had lower limb amputation due to severe infection and prolonged ischemia time.
This series of patients demonstrates that cross limb vessel transfer is an invaluable technique to salvage the limb in patients with complex vascular injury and wound infection. However, for lower limb with prolonged ischemia time and severe infection, limb salvage is not recommended.
四肢的复杂损伤很难治疗。在软组织感染和血管缺损的情况下，动脉重建术的失败风险很高。历史上，对于这些严重损伤的肢体，成功挽救的选择并不多。我们介绍了使用跨肢体血管转移来挽救肢体的经验。
回顾性地确定了患有四肢复杂血管损伤和伤口感染的患者，他们接受了跨肢体血管转移治疗。一旦感染得到成功清除，就进行血流通过皮瓣转移，以明确重建动脉损伤。收集的数据包括患者的人口统计学资料、损伤和手术细节以及术后结果，包括肢体的血液供应、伤口感染和并发症。
2014 年 4 月至 2017 年 1 月期间，有 3 名平均年龄为 21 岁（范围，16-29 岁）的患者入院。中位住院时间为 62 天（范围，26-122 天）。平均手术次数为 7.3 次（范围，6-10 次）。两名患者的上肢存活，但活动受限，供区并发症相对较小，使用 CTA 确认血管重建的血流通过，而一名患者下肢因严重感染和长时间缺血而截肢。
本系列患者表明，在患有复杂血管损伤和伤口感染的患者中，跨肢体血管转移是挽救肢体的宝贵技术。然而，对于下肢缺血时间长且感染严重的患者，不建议进行肢体挽救。
