Cikrit D F, Nichols W K, Silver D
Department of Surgery, University of Missouri, Columbia 65212.
J Vasc Surg. 1988 Mar;7(3):473-8. doi: 10.1067/mva.1988.avs0070473.
A 15-year experience with 27 patients, 20 to 75 years of age, with refractory venous stasis ulcers is presented. All patients had been managed with support hose, elevation, elastic wraps, Unna's paste boots, and graduated compression stockings. Because of multiple recurrences of their ulcers, the patients were offered surgical treatment to reduce the venous hypertension in the areas of ulceration. The 27 patients had 32 modified Linton procedures. Five had bilateral procedures. At the time of operation, 18 limbs had medial malleolar ulcers, five had bimalleolar ulcers, four had lateral ulcers, three had posterior ulcers, and two patients were free of ulcer. Medial incisions were used in 20 limbs, lateral incisions in six, medial and lateral incisions in three, and midposterior incisions in three. Split-thickness skin grafts were placed on six limbs the day of surgery and on 22 limbs 4 to 7 days later. Postoperative complications included deep venous thrombosis in two, partial flap necrosis in three, and cellulitis of the lower leg in three patients. Follow-up has ranged from 6 months to 10 years. During the most recent clinic visits, 21 limbs were completely healed, whereas six limbs had a recurrence of the ulcer. Five patients have been lost to follow-up. The good long-term results in 78% of the cases indicate that patients with recurrent venous stasis ulcers may receive lasting benefit from modified Linton procedures.
本文介绍了对27例年龄在20至75岁之间患有难治性静脉淤滞性溃疡患者的15年治疗经验。所有患者均接受过弹力袜、抬高患肢、弹性绷带、尤纳糊靴和分级压力袜等治疗。由于溃疡多次复发，这些患者接受了手术治疗，以降低溃疡部位的静脉高压。这27例患者共接受了32次改良林顿手术。5例患者接受了双侧手术。手术时，18条肢体有内踝溃疡，5条有双踝溃疡，4条有外踝溃疡，3条有后踝溃疡，2例患者无溃疡。20条肢体采用内侧切口，6条采用外侧切口，3条采用内侧和外侧切口，3条采用后正中切口。6条肢体在手术当天进行了中厚皮片移植，22条肢体在4至7天后进行了移植。术后并发症包括2例深静脉血栓形成、3例部分皮瓣坏死和3例小腿蜂窝织炎。随访时间为6个月至10年。在最近的门诊随访中，21条肢体完全愈合，而6条肢体溃疡复发。5例患者失访。78%的病例取得了良好的长期效果，表明复发性静脉淤滞性溃疡患者可能从改良林顿手术中获得持久益处。
