Kobayashi Koichi, Shinoura Susumu, Nishimura Ken, Masuyama Naoko
From the Department of Orthopedic Surgery, Kanto Rosai Hospital, Kawasaki-shi, Kanagawa-ken, Japan.
Department of Gastroenterology, International University of Health and Welfare, Narita-shi, Chiba-ken, Japan.
Plast Reconstr Surg Glob Open. 2024 Mar 4;12(3):e5638. doi: 10.1097/GOX.0000000000005638. eCollection 2024 Mar.
Revascularization surgery has been reported to have a higher success rate than replantation due to sufficient venous return. However, in complex cases, success depends on a wide range of indications. This study aimed to investigate success rates in cohorts that included severe cases.
This single-center, noninterventional, retrospective cohort study included 292 patients (349 digits) who underwent revascularization or replantation at our institution between January 2000 and December 2022. Sex, age, smoking history, comorbidities, affected digit, amputation level, complete or incomplete amputation, type of fracture and mechanism, artery diameter, needle, vein anastomosis in the revascularization subgroup, vein grafting, warm ischemic time, and outcomes were investigated and compared between the revascularization and replantation subgroups of the distal and proximal amputation groups.
In the distal amputation group, the arterial diameter in the revascularization subgroup was larger than that in the replantation subgroup ( < 0.05). In the proximal amputation group, the revascularization subgroup had a lower frequency of multiple amputations than the replantation subgroup ( < 0.05). Vein grafts were more frequently used in both revascularization subgroups than in the replantation subgroups ( < 0.05). However, the other injury severity indices were similar, and the success rates were not significantly different between the subgroups.
The revascularization success rate was similar to that of replantation. Vein anastomosis or vein grafting to the veins should be advocated for revascularization in severe cases where skin bridges may not have sufficient venous return.
据报道，由于静脉回流充足，血管重建手术的成功率高于断指再植。然而，在复杂病例中，成功取决于广泛的适应症。本研究旨在调查包括严重病例在内的队列中的成功率。
这项单中心、非干预性、回顾性队列研究纳入了2000年1月至2022年12月期间在本机构接受血管重建或断指再植的292例患者（349指）。调查并比较了远端和近端截肢组的血管重建和断指再植亚组之间的性别、年龄、吸烟史、合并症、患指、截肢水平、完全或不完全截肢、骨折类型和机制、动脉直径、针、血管重建亚组中的静脉吻合、静脉移植、热缺血时间和结果。
在远端截肢组中，血管重建亚组的动脉直径大于断指再植亚组（<0.05）。在近端截肢组中，血管重建亚组的多处截肢频率低于断指再植亚组（<0.05）。两个血管重建亚组中静脉移植的使用频率均高于断指再植亚组（<0.05）。然而，其他损伤严重程度指标相似，亚组之间的成功率无显著差异。
血管重建成功率与断指再植相似。对于皮肤桥静脉回流可能不足的严重病例，血管重建应提倡静脉吻合或静脉移植至静脉。
