Kuyama T, Umemura H, Sudo T, Kawamura M, Shobu R, Tsubakimoto R, Nishimoro A
Second Department of Surgery, School of Medicine, Kinki University, Osaka, Japan.
Nihon Geka Gakkai Zasshi. 1988 May;89(5):763-70.
In cases of ischemic extremities and diabetes mellitus, the trauma on finger and toe is very intractable. For such injuries amputation of extremity is indicated very often because of severe necrosis. The number of such cases has been increasing recently because many cases of these patients have arteriosclerotic arterial occlusion and diabetes mellitus, and these are correlated with the changes of aging. The number of cases of Buerger's disease has been also increasing and it is another etiology of intractable trauma in ischemic extremity. The repeated hyperbaric oxygenation, sympathetic block, warfarin therapy and insulin bath with bubbling of hyperbaric oxygen, were applied to has been of such necrosis. By these procedures, the rate of amputation of extremity decreasing. It was concluded that the surgical reconstruction of artery for ischemic extremity has never any meaning as the therapy of such intractable injuries, if blood flow in the peripheral tissue is not kept physiologically, before vascular reconstruction. In order to increase peripheral tissue circulation, the hyperbaric oxygenation, sympathetic block and warfarin therapy wer performed in many cases and these methods were very effective for intractable injuries with severe necrosis.
在缺血性肢体和糖尿病病例中，手指和脚趾的创伤非常难以处理。对于此类损伤，由于严重坏死，肢体截肢常常是必要的。近年来，这类病例的数量一直在增加，因为许多患者同时患有动脉硬化性动脉闭塞和糖尿病，而这些都与衰老变化相关。血栓闭塞性脉管炎的病例数量也在增加，它是缺血性肢体顽固性创伤的另一个病因。对于此类坏死，采用了反复高压氧治疗、交感神经阻滞、华法林治疗以及高压氧鼓泡胰岛素浴等方法。通过这些措施，肢体截肢率有所下降。得出的结论是，如果在血管重建之前外周组织的血流不能维持在生理水平，那么对于这种顽固性损伤的治疗，缺血性肢体的动脉外科重建毫无意义。为了增加外周组织循环，许多病例采用了高压氧治疗、交感神经阻滞和华法林治疗，这些方法对于伴有严重坏死的顽固性损伤非常有效。
