Department of Orthopedic Surgery, Research Institute of Clinical Medicine of Jeonbuk National University - Biomedical Research Institute of Jeonbuk National University Hospital, Jeonju, Jeonbuk, Republic of Korea.
Department of Orthopedic Surgery, Gwangyang Seoul Hospital, Gwangyang, Jeonnam, Republic of Korea.
Medicine (Baltimore). 2024 Jun 7;103(23):e38385. doi: 10.1097/MD.0000000000038385.
Patients with traumatic ischemic mangled extremities first undergo arterial reconstruction using autogenous vein grafts, followed by flap transplantation as a staged treatment for soft tissue reconstruction. This study aimed to report the outcomes of such a staged treatment. Thirteen patients underwent arterial reconstruction between February 2015 and April 2017 due to damage to the major blood vessels by the traumatic mangled extremities. Of them, 6 patients (5 males and 1 female with a mean age of 51 years, age range: 36-60 years) who underwent soft tissue reconstruction due to necrosis were retrospectively analyzed. The average Mangled Extremity Severity Score was 7.2 (range, 6-8). Injuries were found in the lower leg (4 cases), foot (1 case), and wrist and hand (1 case). Arterial reconstruction was performed using autologous venous grafts. The reconstructed arteries included the posterior tibial artery (3 cases), anterior tibial artery (1 case), dorsalis pedis artery (1 case), and radial artery (1 case). The blood circulation status of the reconstructed blood vessels was assessed using computed tomography angiography at an average of 5 weeks (range, 4-6 weeks) after arterial reconstruction. For some necrotic soft tissues, debridement and flap transplantation were performed an average of 7 weeks (range, 6-8 weeks) after arterial reconstruction. Soft tissue reconstruction was performed with an anterolateral thigh free flap in 4 cases, a local flap in 1 case, and a muscle flap in 1 case. In 5 out of 6 cases, blood circulation was maintained in the reconstructed blood vessels, resulting in the salvaging of the extremities. All the patients who underwent flap surgery survived. Notably, there were no special complications during a follow-up visit conducted at an average of 19 months post-reconstruction. To treat an ischemic mangled extremity, the limbs should first be salvaged with arterial reconstruction, followed by subsequent appropriate flap surgery when soft tissue necrosis occurs at the mangled site as a staged treatment.
创伤性缺血性毁损肢体的患者首先进行自体静脉移植的动脉重建，然后进行分期治疗的皮瓣移植以重建软组织。本研究旨在报告这种分期治疗的结果。2015 年 2 月至 2017 年 4 月，由于创伤性毁损肢体导致主要血管损伤，13 例患者接受了动脉重建。其中，6 例（5 名男性和 1 名女性，平均年龄 51 岁，年龄范围：36-60 岁）由于坏死而接受软组织重建的患者进行了回顾性分析。平均损毁肢体严重程度评分（Mangled Extremity Severity Score）为 7.2（范围：6-8）。损伤位于小腿（4 例）、足部（1 例）和腕部及手部（1 例）。使用自体静脉移植物进行动脉重建。重建的动脉包括胫后动脉（3 例）、胫前动脉（1 例）、足背动脉（1 例）和桡动脉（1 例）。在动脉重建后平均 5 周（范围：4-6 周）使用计算机断层血管造影术评估重建血管的血液循环状态。对于一些坏死的软组织，在动脉重建后平均 7 周（范围：6-8 周）进行清创和皮瓣移植。软组织重建采用 4 例股前外侧游离皮瓣、1 例局部皮瓣和 1 例肌皮瓣。在 6 例中有 5 例重建血管的血液循环得以维持，从而挽救了肢体。所有接受皮瓣手术的患者均存活。值得注意的是，在重建后平均 19 个月的随访期间，没有发生特殊并发症。为了治疗缺血性毁损肢体，应首先进行动脉重建以挽救肢体，然后在毁损部位发生软组织坏死时进行后续适当的皮瓣手术，作为分期治疗。
