Department of Microsurgery, Orthopaedic Trauma and Hand Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
Guangdong Provincial Key Laboratory of Orthopaedics and Traumatology, Guangzhou, China.
J Invest Surg. 2022 Jul;35(7):1562-1570. doi: 10.1080/08941939.2022.2055237. Epub 2022 Mar 31.
This study aimed to investigate outcomes after extremity arterial injury repair and examined the association between outcomes and the degree of soft tissue injury and vascular repair methods.
A retrospective study was conducted on 106 patients (108 cases) who underwent emergent microsurgical repair of extremity arterial injury due to trauma and non-perfusion of the affected extremity. The cases were divided into three groups by degree of associated soft tissue injuries: (A) adequate soft tissue coverage over the injured major vessels after radical debridement, (B) inadequate soft tissue coverage over the injured major vessels after radical debridement, and (C) radical debridement was not feasible due to unclear extent of injured soft tissue. Differences in vascular repair methods and outcomes among the three groups were analyzed.
In Group A (n = 61), microvascular suture and vessel graft achieved 95.1% and 85.0% successful limb reperfusion, respectively. In Group B (n = 31), vessel reconstruction with flap coverage achieved 100% successful reperfusion. Vessel graft achieved 28.6% successful limb reperfusion, while there were no cases of successful reperfusion using microvascular sutures. In Group C (n = 16), no vascular repair method achieved successful reperfusion. There were significant differences among the three groups in successful reperfusion ( < 0.001) and limb salvage ( < 0.001).
The extent of associated soft tissue injury was associated with different vascular repair methods and outcomes. We propose a new system for classifying these injuries according to the degree of associated soft tissue injury.
本研究旨在探讨四肢动脉损伤修复后的结果，并研究结果与软组织损伤程度和血管修复方法之间的关系。
对 106 例（108 例）因创伤和受累肢体无灌注而行急诊显微修复的四肢动脉损伤患者进行回顾性研究。根据伴发软组织损伤的程度将病例分为三组：（A）彻底清创后主要血管有足够的软组织覆盖，（B）彻底清创后主要血管的软组织覆盖不足，（C）由于伴发软组织损伤的范围不清，无法进行彻底清创。分析三组间血管修复方法和结果的差异。
在 A 组（n=61）中，微血管缝合和血管移植分别实现了 95.1%和 85.0%的肢体再灌注成功。在 B 组（n=31）中，带蒂皮瓣覆盖的血管重建实现了 100%的再灌注成功。血管移植实现了 28.6%的肢体再灌注成功，而微血管缝合无一例成功再灌注。在 C 组（n=16）中，没有一种血管修复方法实现了成功再灌注。三组间再灌注（<0.001）和肢体挽救（<0.001）成功率有显著差异。
伴发软组织损伤的程度与不同的血管修复方法和结果有关。我们根据伴发软组织损伤的程度提出了一种新的分类系统。
