Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Martin-Luther Hospital Berlin, Berlin, Germany; Department of Hand-, Plastic and Reconstructive Surgery, Burn Center, BG Trauma Center Ludwigshafen, Ludwigshafen, Germany.
Department of Plastic, Reconstructive and Aesthetic Surgery, Hand Surgery, Martin-Luther Hospital Berlin, Berlin, Germany.
Ann Vasc Surg. 2023 Jan;88:108-117. doi: 10.1016/j.avsg.2022.07.019. Epub 2022 Aug 24.
Large, full-thickness infrainguinal wounds following revision revascularization procedures of the lower extremity are a challenging complication for reconstructive surgery. Frequently, these patients present with various comorbidities and after several previous reconstructive attempts. Therefore no straightforward soft tissue reconstruction is likely.
Patients who presented with large, complex inguinal wounds for soft tissue reconstruction were analyzed retrospectively in terms of flap choice, outcome, and complication rates. A focus was set on the reconstructive technique and a subgroup analysis was assessed.
Nineteen patients (11 men, 8 women) who received 19 flaps (17 pedicled, 2 free flaps) were included in this retrospective study. Average patient age was 73.3 years (range: 53-88). Ten fasciocutaneous flaps (anterolateral thigh [ALT], 52.6%) and 9 muscle flaps (47.4%) were applied. Among muscle flaps, 3 pedicled gracilis flaps, 4 pedicled rectus abdominis flaps, and 2 free latissimus dorsi flaps were used. No flap losses were observed except 1 case of limited distal flap necrosis (gracilis group). Body mass index ranged from 19 to 37, mean 26.8. Mean surgery time in all patients was 165.9 min (range: 105-373). Revision surgery due to local wound healing problems averaged 1.6 in all patients. In all cases sufficient soft tissue reconstruction was achieved and bypasses were preserved. Lengths of stay averaged 27.2 days (range: 14-59). Mortality was considerably (10.5%) due to systemic complications (one patient died due to a heart attack 4 weeks postoperatively, another patient died due to an extensive pulmonary embolism 2 weeks postoperatively).
Soft tissue reconstruction of complex inguinal wounds after revision vascular surgery is challenging and wound healing problems are expectable. In addition to the rectus abdominis flap the pedicled ALT flap is feasible in a broad variety of medium to large wounds. Free flap reconstruction is recommended for very large defects. A structured interdisciplinary approach is required for the management of complex wounds after vascular surgery to prevent and to deal with complications and perioperative morbidity.
下肢血管修复再造术后出现大而全层的下肢慢性难愈性创面是外科重建的一大挑战。这些患者常合并多种合并症，且经过多次重建尝试。因此，通常难以进行简单的软组织修复。
回顾性分析了因软组织修复而就诊的大而复杂的腹股沟创面患者，内容包括皮瓣选择、结果和并发症发生率。重点关注重建技术，并进行了亚组分析。
本研究共纳入 19 例患者（11 名男性，8 名女性），共进行了 19 次皮瓣转移术（17 次带蒂，2 次游离）。患者平均年龄为 73.3 岁（范围：53-88 岁）。10 例应用筋膜皮瓣（股前外侧皮瓣，52.6%），9 例应用肌肉皮瓣（47.4%）。在肌肉皮瓣中，3 例应用带蒂大收肌皮瓣，4 例应用带蒂腹直肌皮瓣，2 例应用游离背阔肌皮瓣。除 1 例（大收肌组）出现局限性远端皮瓣坏死外，无皮瓣坏死发生。患者体质量指数（BMI）范围为 19-37，平均 26.8。所有患者的平均手术时间为 165.9 分钟（范围：105-373 分钟）。所有患者均因局部伤口愈合问题进行了 1.6 次的翻修手术。所有患者均实现了充分的软组织重建，且保留了旁路。平均住院时间为 27.2 天（范围：14-59 天）。由于全身并发症（1 例患者术后 4 周因心脏病发作死亡，另 1 例患者术后 2 周因广泛肺栓塞死亡），死亡率相当高（10.5%）。
下肢血管修复再造术后慢性难愈性腹股沟创面的软组织修复极具挑战性，且预计会出现伤口愈合问题。除了腹直肌皮瓣外，带蒂股前外侧皮瓣也适用于多种中大型创面。对于非常大的缺损，建议进行游离皮瓣重建。为了预防和处理血管外科术后复杂创面的并发症和围手术期并发症，需要进行多学科的结构化处理。
