Wood M R, Hunter G A, Millstein S G
Amputee Clinic, Ontario Workers' Compensation Board.
Prosthet Orthot Int. 1987 Aug;11(2):71-4. doi: 10.3109/03093648709078181.
One hundred and twenty adult patients were reviewed in whom split skin grafts were applied to the stump following traumatic amputation of the upper limb (44 amputees) or lower limb (76 amputees). The average follow-up period was seven and a half years after initial amputation. There was delay in prosthetic fitting in all patients. Approximately one third of patients complained of occasional minor ulceration, controlled by removing the prosthesis for a few days or modification of the prosthesis. Further revision surgery, including excision of the grafted skin often combined with proximal bone resection, but not removal of the proximal joint, was necessary in 29% of below-elbow amputees and approximately 50% of below and above-knee amputees. At the above-elbow level, use of skin grafts allowed prosthetic fitting because of preservation of sufficient length of the stump. Despite the fact that revision surgery may often be necessary, split skin grafting has a definite place in the early management of the stump following traumatic limb amputation in the adult. Preservation of stump length with the knee or elbow joint allows easier rehabilitation and lower energy expenditure when using the prosthesis. Partial foot amputation, when combined with skin grafting usually requires subsequent revision to a more proximal level to obtain a satisfactory result.
对120例成年患者进行了回顾性研究，这些患者在上肢（44例截肢者）或下肢（76例截肢者）外伤性截肢后，在残端应用了中厚皮片移植。初次截肢后的平均随访期为七年半。所有患者的假肢安装均有延迟。约三分之一的患者抱怨偶尔出现轻微溃疡，通过取下假肢几天或对假肢进行调整即可控制。在29%的肘下截肢者和约50%的膝下及膝上截肢者中，需要进一步的翻修手术，包括切除移植皮肤，通常还需结合近端骨切除，但不切除近端关节。在肘上水平，由于保留了足够长度的残端，使用皮片移植可进行假肢安装。尽管通常可能需要翻修手术，但在成人外伤性肢体截肢后的残端早期处理中，中厚皮片移植有明确的地位。保留带有膝关节或肘关节的残端长度，在使用假肢时可使康复更容易且能量消耗更低。部分足截肢与皮片移植结合时，通常需要随后向更近端水平进行翻修以获得满意结果。
