The Warren Alpert Medical School of Brown University, Providence, RI, USA.
Hand (N Y). 2024 Jul;19(5):814-822. doi: 10.1177/15589447231151261. Epub 2023 Feb 3.
Individuals with end-stage renal disease (ESRD) and fingertip wounds are at high risk of poor wound healing, ultimately requiring amputations. Optimal performance of upper extremity amputation (UEA) in patients with ESRD is important to decrease complications and minimize total operative procedures needed. This study evaluated outcomes of UEA in patients with ESRD and described risk factors predisposing patients to complications.
A retrospective analysis of patients receiving nontraumatic UEA for fingertip wounds was conducted, stratified by patients with and without ESRD. Demographics, comorbidities, complications, and hospital course were analyzed between groups for differences. Subanalysis of patients with ESRD was conducted to characterize operative course and predictors of complications.
A total of 132 patients were included, 106 controls and 26 with ESRD. Compared with controls, patients with ESRD required more amputations ( < .001) and total operations ( < .001) to achieve wound healing. Patients with ESRD experienced higher rates of postoperative complications ( < .001). Predictors for complications in patients with ESRD were comorbid diabetes (odds ratio [OR]: 45; 95% confidence interval [CI], 1.7-1226.9), vascular disease (OR: 30; 95% CI, 2-441.8), arterial calcification (OR: 18; 95% CI, 1.56-207.5), and presence of a hemodialysis shunt in the affected arm (OR: 18; 95% CI, 1.56-207.5). Within patients with ESRD, initial amputation at, or proximal to, the metacarpophalangeal joint (MCPJ) led to fewer amputations (1.2 vs 2.19, = .04) and fewer total operative procedures (4.1 vs 6.6, = .03), compared with initial amputation distal to the MCPJ.
In nontraumatic fingertip wounds, patients with ESRD had worse operative outcomes than patients without ESRD. More aggressive management of fingertip wounds using earlier and more proximal initial amputations may expedite wound healing in certain high-risk patients with ESRD.
患有终末期肾病（ESRD）的个体和指尖伤口处于伤口愈合不良的高风险中，最终需要截肢。在 ESRD 患者中进行最佳的上肢截肢（UEA）操作对于减少并发症和尽量减少所需的总手术过程非常重要。本研究评估了 ESRD 患者 UEA 的结果，并描述了使患者容易发生并发症的危险因素。
对接受非创伤性 UEAs 治疗指尖伤口的患者进行回顾性分析，按有无 ESRD 分层。分析组间的人口统计学、合并症、并发症和住院过程以确定差异。对患有 ESRD 的患者进行亚分析，以描述手术过程和并发症的预测因素。
共纳入 132 例患者，106 例为对照组，26 例为 ESRD 组。与对照组相比，ESRD 患者需要更多的截肢（<0.001）和总手术（<0.001）来实现伤口愈合。ESRD 患者术后并发症发生率更高（<0.001）。ESRD 患者并发症的预测因素为合并糖尿病（优势比 [OR]：45；95%置信区间 [CI]，1.7-1226.9）、血管疾病（OR：30；95%CI，2-441.8）、动脉钙化（OR：18；95%CI，1.56-207.5）和受影响手臂中有血液透析分流器（OR：18；95%CI，1.56-207.5）。在 ESRD 患者中，与 MCPJ 近端或近端的初始截肢（1.2 次与 2.19 次，=0.04）和更少的总手术次数（4.1 次与 6.6 次，=0.03）相比，MCPJ 处或近端的初始截肢导致更少的截肢和更少的总手术次数。
在非创伤性指尖伤口中，ESRD 患者的手术结果比非 ESRD 患者差。在某些患有 ESRD 的高风险患者中，使用更早和更靠近近端的初始截肢来更积极地处理指尖伤口可能会加速伤口愈合。
