Tsuji Yoshihiko, Kitano Ikuro, Tsuji Yoriko
Department of Vascular Surgery, Shinsuma General Hospital.
Department of Plastic Surgery, Shinsuma General Hospital.
Ann Vasc Dis. 2020 Sep 25;13(3):286-290. doi: 10.3400/avd.oa.20-00064.
: In paramalleolar bypass for critical limb-threatening ischemia (CLTI), excessive skin tension may occur for the closure of surgical wounds around the ankle. Furthermore, these surgical incisions are often proximal to infectious ischemic ulcers. Wound dehiscence caused by skin tension and surgical site infection carries a risk of graft exposure, anastomotic disruption, or graft insufficiency. : Tension-free wound management was adopted in eight patients who underwent paramalleolar bypass for CLTI. Tension-free closure was adopted for surgical incisions for distal anastomotic site of the paramalleolar bypass, whereas the incisions for saphenous vein harvest were left open. A relief incision was made as needed. The opened incisions were covered with artificial dermis. : All surgical incisions and ischemic wounds healed successfully within 1.8 months after bypass. Two postoperative graft stenoses occurred, which were rescued by additional endovascular intervention. Secondary graft patency, wound healing, and limb salvage rates were 100% during an average follow-up period of 30 months. : Tension-free wound closure using artificial dermis was effective in selected cases of paramalleolar bypass for CLTI.
在用于治疗严重肢体缺血（CLTI）的踝周旁路手术中，踝关节周围手术切口闭合时可能会出现皮肤张力过大的情况。此外，这些手术切口通常靠近感染性缺血性溃疡。皮肤张力和手术部位感染导致的伤口裂开存在移植物暴露、吻合口破裂或移植物功能不全的风险。
八例接受踝周旁路手术治疗CLTI的患者采用了无张力伤口处理方法。踝周旁路手术远端吻合口部位的手术切口采用无张力缝合，而大隐静脉采集部位的切口则敞开。根据需要做减张切口。敞开的切口用人造真皮覆盖。
旁路手术后1.8个月内，所有手术切口和缺血性伤口均成功愈合。术后发生两例移植物狭窄，经额外的血管内介入治疗后好转。在平均30个月的随访期内，二次移植物通畅率、伤口愈合率和肢体挽救率均为100%。
对于CLTI患者的踝周旁路手术，在特定病例中使用人造真皮进行无张力伤口闭合是有效的。
