Briggs S E, Banis J C, Kaebnick H, Silverberg B, Acland R D
J Vasc Surg. 1985 Nov;2(6):806-11. doi: 10.1067/mva.1985.avs0020806.
Most lower extremity amputations result from complications of diabetes and arterio-sclerotic occlusive diseases below the inguinal ligament. Improved limb salvage has been achieved by an aggressive approach to distal revascularization in the severely ischemic lower extremity. There remains, however, a high incidence of amputation resulting from progression of the ulceration or gangrene into deeper and less well-vascularized tissues, such as tendon and bone. Even in the nonischemic extremity, such wounds rarely heal without flap coverage. Microvascular free tissue transfers promote healing by providing coverage with healthy, nondiseased, well-vascularized tissue for these difficult defects. Successful free flap transfer requires a high-pressure recipient inflow vessel. In contrast to individuals with nonarteriosclerotic lesions, many individuals with nonhealing ischemic lesions have no acceptable artery demonstrated on high-resolution angiography to serve as a recipient vessel. Limb salvage has been achieved in four candidates for amputation utilizing distal revascularization followed by free tissue transfer coverage of the ischemic lower leg defects.
大多数下肢截肢是由糖尿病并发症以及腹股沟韧带以下的动脉硬化闭塞性疾病引起的。通过对严重缺血的下肢采取积极的远端血管重建方法，肢体挽救情况有所改善。然而，由于溃疡或坏疽进展至更深层且血管化程度较差的组织（如肌腱和骨骼），截肢发生率仍然很高。即使在非缺血性肢体中，此类伤口若无皮瓣覆盖也很少能愈合。微血管游离组织移植通过为这些困难缺损提供健康、无病变且血管化良好的组织覆盖来促进愈合。成功的游离皮瓣移植需要一条高压的受区流入血管。与非动脉硬化性病变患者不同，许多缺血性病变不愈合的患者在高分辨率血管造影中未显示出可作为受区血管的合适动脉。通过远端血管重建，随后对缺血性小腿缺损进行游离组织移植覆盖，四名截肢候选者实现了肢体挽救。
