Georgetown University School of Medicine, Washington, District of Columbia, USA.
Department of Plastic and Reconstructive Surgery and MedStar Georgetown University Hospital, Washington, District of Columbia, USA.
Adv Wound Care (New Rochelle). 2022 Jan;11(1):10-18. doi: 10.1089/wound.2020.1380. Epub 2021 Feb 17.
To evaluate our institutional outcomes of surgical management of lower extremity (LE) wounds in the solid organ transplant recipient population. An 8-year retrospective review was conducted for all solid organ transplantation (SOT) recipients with LE wounds necessitating surgical management at our tertiary limb salvage center. Outcomes of interest included wound healing, surgical treatment, progression to amputation, and amputation level. Factors contributing to amputation progression were analyzed. The article adheres to the Strengthening the Reporting of Observational Studies in Epidemiology statement. Sixty-four SOT recipients underwent surgical management for their LE wounds between 2010 and 2018. Median number of surgeries per patient was 5 (interquartile range = 2-8); 47 of 64 patients (73.4%) underwent amputation, and 17 of 64 patients (26.6%) underwent nonamputation surgical management. In the amputation group, the majority of primary amputations were minor (42/47, 89.4%); 24 of 42 (57.1%) patients progressed to a higher amputation level, 16 of 42 (38.1%) healed after their index procedure, and 2 of 42 (4.8%) were lost to follow-up (LTFU) after their primary minor amputation. Five of 47 (10.6%) patients undergoing amputations required primary below-knee amputations. In the nonamputation group, 15 of 17 (88.2%) healed, 1 of 17 (5.9%) expired, and 1 of 17 (5.9%) was LTFU. To identify the outcomes of patients undergoing surgical management for LE wounds after SOT and elucidate clinical factors that impact the rate of limb salvage. This is the first comprehensive analysis of LE wounds in the transplant population. Our analysis indicates high rates of failed minor amputation, and frequent progression to major amputation in SOT patients. Preexisting comorbidities and immunosuppressive regimens complicate limb salvage; therefore, further research is warranted to optimize surgical LE wound management in this population.
为了评估我们机构对实体器官移植受者下肢（LE）伤口的手术治疗结果。对我院三级保肢中心接受手术治疗的所有 LE 伤口需要手术治疗的实体器官移植（SOT）受者进行了为期 8 年的回顾性研究。感兴趣的结果包括伤口愈合、手术治疗、进展至截肢和截肢水平。分析了导致截肢进展的因素。本文遵循《加强观察性研究的报告》声明。2010 年至 2018 年间，64 名 SOT 受者因 LE 伤口接受手术治疗。每位患者的平均手术次数为 5 次（四分位距=2-8）；64 例患者中有 47 例（73.4%）接受了截肢，64 例患者中有 17 例（26.6%）接受了非截肢手术治疗。在截肢组中，大多数初次截肢为小截肢（42/47，89.4%）；24/42（57.1%）患者进展至更高的截肢水平，16/42（38.1%）在首次手术后愈合，2/42（4.8%）在初次小截肢后失访（LTFU）。47 例截肢患者中有 5 例（10.6%）需要初次膝下截肢。在非截肢组中，17 例中有 15 例（88.2%）愈合，1 例（5.9%）死亡，1 例（5.9%）失访。确定 SOT 后接受 LE 伤口手术治疗患者的结果，并阐明影响保肢率的临床因素。这是对移植人群中 LE 伤口的首次全面分析。我们的分析表明，SOT 患者小截肢失败率高，且常进展为大截肢。既往合并症和免疫抑制方案使保肢复杂化；因此，需要进一步研究以优化该人群的 LE 伤口手术治疗。
