初探大血管系统对跖骨间截肢成功的影响。

A Preliminary Look at the Macrovascular System for Transmetatarsal Amputation Success.

机构信息

Elizabeth Ansert, DPM, MBA, MA, is Podiatric Resident, Saint Vincent Hospital, Worcester, Massachusetts, USA. John Najjar, MD, is Vascular Surgeon, Reliant Medical Group, Worcester, Massachusetts. Robert J. Snyder, DPM, MBA, MSc, CWSP, is Dean, Podiatric Medical School, Barry University School of Podiatric Medicine, Miami, Florida. Acknowledgment: The authors thank the vascular surgeons involved in data collection. The authors have disclosed no financial relationships related to this article. Submitted October 30, 2022; accepted in revised form January 9, 2023.

出版信息

Adv Skin Wound Care. 2023 Nov 1;36(11):610-615. doi: 10.1097/ASW.0000000000000057.

DOI:10.1097/ASW.0000000000000057

PMID:37861666

Abstract

OBJECTIVE

Transmetatarsal amputation (TMA) is a commonly used level of amputation that preserves most of the foot's function and independence. However, many TMAs fail, and patients go onto higher amputations. The primary endpoint of this study is to determine if source artery occlusions are correlated with TMA flap failure.

METHODS

A total of 82 patients with TMAs were retrospectively reviewed for healing rates between 2009 and 2019 at a single center. Forty-five of the patients had an angiogram, which was analyzed for source artery and overall TMA failure. Of the initial 82 patients, a cohort of 12 had documentation of specific flap failure and an angiogram performed. This cohort of 12 patients was used for correlation of flap failure with source artery occlusion.

RESULTS

Overall, the TMA healing rate was 45.28%. No correlation was noted between a specific source artery occlusion and overall TMA failure. However, a moderate positive correlation was seen with dorsalis pedis artery and peroneal artery occlusions and dorsal flap failure. No correlation was seen with the posterior tibial artery and plantar flap failure. A moderate negative correlation was seen with peroneal artery occlusion and plantar flap failure.

CONCLUSIONS

The authors concluded that retrograde flow through the angiosome principle is what allowed for successful outcomes in TMAs. Physicians are urged to carefully plan, dissect, and preserve these vessels to help prevent TMA flap failure, especially in patients with vascular risk or disease.

摘要

目的

跖骨间截肢（TMA）是一种常用的截肢水平，可保留脚部的大部分功能和独立性。然而，许多 TMA 会失败，患者需要进行更高水平的截肢。本研究的主要终点是确定源动脉阻塞是否与 TMA 皮瓣失败相关。

方法

回顾性分析了 2009 年至 2019 年在一家单中心接受 TMA 的 82 例患者的愈合率。其中 45 例患者接受了血管造影检查，分析了源动脉和 TMA 整体失败的情况。在最初的 82 例患者中，有 12 例患者的特定皮瓣失败和血管造影检查有记录。该 12 例患者队列用于皮瓣失败与源动脉阻塞的相关性分析。