Royal Gwent Hospital, Aneurin Bevan Health Board, Newport, UK.
Artificial Limb and Appliance Centre, Rookwood Hospital, Cardiff, UK.
Eur J Vasc Endovasc Surg. 2020 Aug;60(2):301-308. doi: 10.1016/j.ejvs.2020.03.049. Epub 2020 Apr 24.
To compare outcomes between long posterior flap (LPF) and skew flap (SF) amputation over a 13 year period.
This was a retrospective observational cohort study. Consecutive patients undergoing a LPF or SF below knee amputation (BKA) over a 13 year period at one hospital were identified. Both techniques were performed regularly, depending on tissue loss and surgeon preference. The primary outcome was surgical revision of any kind. Secondary outcomes included revision to above knee amputation (AKA), length of hospital stay (LOS), and mortality. A smaller cohort of patients who were alive and unilateral below knee amputees were contacted to ascertain prosthetic use and functional status.
In total, 242 BKAs were performed in 212 patients (125 LPF and 117 SF; median follow up 25.8 months). Outcomes for the two groups were equivalent for surgical revision of any kind (27 LPF vs. 31 SF; p = .37), revision to an AKA (18 LPF vs. 14 SF; p = .58), LOS (29 days for LPF vs. 28 days for SF; p = .83), and median survival (23.9 months for LPF vs. 28.8 months for SF; p = .89). Multivariable analysis found amputation type had no effect on any outcome. Functional scores from a smaller cohort of 40 unilateral amputees who were contactable demonstrated improved outcomes with the LPF vs. the SF (p = .038).
Both techniques appear equivalent for rates of surgical residual limb failure. Functional outcomes may be better with the LPF.
比较 13 年间长后皮瓣（LPF）和斜皮瓣（SF）截肢的结果。
这是一项回顾性观察队列研究。在一家医院，连续 13 年间，对接受 LP 或 SF 膝下截肢（BKA）的患者进行了识别。两种技术均根据组织损失和外科医生的偏好定期进行。主要结果是任何类型的手术修正。次要结果包括到膝上截肢（AKA）的修正、住院时间（LOS）和死亡率。联系了一小部分存活且单侧膝下截肢的患者，以确定假体使用和功能状态。
共有 212 例患者接受了 242 例 BKA（125 例 LPF 和 117 例 SF；中位随访 25.8 个月）。两组之间的任何类型手术修正的结果相当（27 例 LPF 与 31 例 SF；p = 0.37），修正为 AKA（18 例 LPF 与 14 例 SF；p = 0.58）， LOS（LPF 为 29 天，SF 为 28 天；p = 0.83）和中位生存时间（LPF 为 23.9 个月，SF 为 28.8 个月；p = 0.89）。多变量分析发现截肢类型对任何结果都没有影响。在可联系的 40 例单侧截肢患者中，较小的功能评分队列显示 LPF 比 SF 具有更好的结果（p = 0.038）。
两种技术在外科残肢失败的发生率方面似乎相当。LPF 的功能结果可能更好。
