Department of Plastic Surgery, The First Affiliated Hospital of Jinan University, Institute of New Technology of Plastic Surgery of Jinan University, Key Laboratory of Regenerative Medicine, Ministry of Education, Guangzhou, China.
Department of Plastic Surgery, Shenzhen Guangming District People's Hospital, Shenzhen, China.
Microsurgery. 2024 Jul;44(5):e31210. doi: 10.1002/micr.31210.
Amputation of the wrist or distal forearm after high-energy trauma due to a crushing mechanism is associated with complex tissue defects, making repair, and reconstruction challenging. Given the difficulty of this type of salvage, patients unfortunately experience a high revision amputation rate. However, a higher quality of life has been reported in patients with successful reconstructions. Herein, we described a protocolized approach for revascularization and reconstruction for functional hand salvage after traumatic amputation from a crushing mechanism using an anterolateral thigh flap (ALT).
A retrospective review was performed between October 2016 and October 2023 for all patients who underwent single-stage emergent debridement, revascularization, and soft tissue coverage using the ALT after amputation at the level of the wrist or distal forearm secondary to high-energy crush injury. Charts were reviewed for the preoperative Mangled Extremity Salvage Score, intraoperative details including what structures were injured and the reconstructive method performed, and postoperative data such as follow-up duration, outcomes, and complications.
Eleven patients met the inclusion criteria with an average age of 35.5 (21-49) years old. The average size of the skin soft tissue defects was 17.3 × 8 cm (range, length: 13-25 cm, width: 6-13 cm), and all cases had associated injury to the underlying bone, nerves, and blood vessels. The average size of the ALT flap used for reconstruction was 19.2 × 9.8 cm (range, length: 14-27 cm, width: 7-15 cm). All patients had survival of the replanted limb. One patient experienced partial flap necrosis that required secondary debridement and skin graft. Nine patients healed without requiring any additional debridement procedures. Patient follow-up averaged 24.6 (12-38) months. All patients achieved satisfactory functional recovery with Grade II to III of Chen's criteria.
For patients with traumatic crush amputation to the wrist with surrounding soft tissue injury, thorough debridement, revascularization, and reconstruction of amputated limbs can be performed in a single stage using the ALT. A protocolized approach from two institutions is presented, demonstrating improved survival and reduced complications of the traumatized limb with improved long-term patient outcomes.
由于挤压机制导致高能创伤而截肢腕部或远侧前臂，会伴有复杂的组织缺损，这使得修复和重建具有挑战性。鉴于这种挽救方式的难度，不幸的是，患者经历高翻修截肢率。然而，有报道称成功重建的患者生活质量更高。在此，我们描述了一种使用股前外侧皮瓣（ALT）对创伤性挤压机制导致的腕部或远侧前臂截肢后进行血运重建和功能手挽救的程序化方法。
对 2016 年 10 月至 2023 年 10 月期间因高能挤压伤而截肢腕部或远侧前臂的所有患者进行了回顾性研究，这些患者均接受了一期紧急清创、血运重建和使用 ALT 的软组织覆盖。对术前损毁程度评分（Mangled Extremity Salvage Score）、术中细节（包括损伤的结构和进行的重建方法）以及术后数据（如随访时间、结果和并发症）进行了回顾。
11 例患者符合纳入标准，平均年龄 35.5（21-49）岁。皮肤软组织缺损的平均大小为 17.3×8cm（范围：长度 13-25cm，宽度 6-13cm），所有患者均伴有骨、神经和血管的损伤。用于重建的 ALT 皮瓣的平均大小为 19.2×9.8cm（范围：长度 14-27cm，宽度 7-15cm）。所有患者的再植肢体均存活。1 例患者发生部分皮瓣坏死，需要二次清创和植皮。9 例患者无需进一步清创而愈合。患者的平均随访时间为 24.6（12-38）个月。所有患者均根据 Chen 标准达到了 II 级至 III 级的满意功能恢复。
对于伴有周围软组织损伤的腕部创伤性挤压截肢患者，可采用 ALT 进行一期彻底清创、血运重建和截肢肢体重建。来自两个机构的程序化方法显示，创伤肢体的存活率提高，并发症减少，患者的长期预后得到改善。
