Rivers S P, Veith F J, Ascer E, Gupta S K
Surgery. 1986 Jun;99(6):759-62.
Fourteen patients with severely ischemic extremities but relatively minor degrees of pedal gangrene or ulceration were managed without surgery. Contraindications to direct arterial reconstruction included significant intercurrent illness or generally poor surgical risk, the need for reoperative or difficult distal reconstruction, or the favorable characteristics of the actual lesion. Management consisted of bed rest, simple saline soaks, occasional gentle debridement, and antibiotics when indicated. Seven patients had complete resolution of their lesions for 3 to 48 months, and seven had improvement or stabilization for 3 to 18 months. Only three of the 14 patients have eventually required surgery with limb salvage in one. Revascularization remains the method of choice for managing most severely ischemic extremities. However, the conservative approach described represents an alternative to early amputation, attempts at revascularization, or lumbar sympathectomy in some patients with advanced ischemia. Studies of sympathectomy and pharmacologic agents as effective treatment for ischemic ulcers or gangrene should include control groups treated with the conservative measures outlined herein.
14例肢体严重缺血但足部坏疽或溃疡程度相对较轻的患者未接受手术治疗。直接动脉重建的禁忌证包括严重的并发疾病或手术风险普遍较差、需要再次手术或远端重建困难，或实际病变具有有利特征。治疗包括卧床休息、简单的盐水浸泡、偶尔轻柔的清创以及必要时使用抗生素。7例患者的病变在3至48个月内完全消退，7例患者的病情在3至18个月内有所改善或稳定。14例患者中最终只有3例需要手术，其中1例成功保肢。血管重建仍然是治疗大多数严重缺血肢体的首选方法。然而，所述的保守方法为一些晚期缺血患者提供了一种替代早期截肢、血管重建尝试或腰交感神经切除术的选择。关于交感神经切除术和药物作为缺血性溃疡或坏疽有效治疗方法的研究应包括采用本文所述保守措施治疗的对照组。
