Chi David, Johnson Anna Rose, Biaggi-Ondina Andrea, Felder John M, Tanaka Shoichiro, Tung Thomas H
Washington University Medical Center, Saint Louis, MO, USA.
Hand (N Y). 2025 Jan 30:15589447251314143. doi: 10.1177/15589447251314143.
High-velocity traumatic amputations of the proximal upper extremity are devastating to the patient and represent an extreme surgical challenge to the treatment team. The hand surgeon must simultaneously battle devascularization with timely microvascular anastomosis, gross contamination with meticulous debridement, and amputation with stable fixation. In restoring a functional extremity, many of these goals are in contention with each other. This case describes a novel management strategy for a left transhumeral amputation sustained by a 23-year-old man in a motorcycle accident. The amputated arm was temporized by ectopic banking via the lateral circumflex femoral artery to allow for thorough debridement and immediate open reduction internal plate fixation with coverage provided by a free omental flap and subsequent split-thickness skin graft. This strategy allows for a single-stage treatment of upper arm amputations with immediate microvascular anastomosis, stable internal fixation, and soft tissue coverage by the omentum providing immunogenic and lymphangiogenic properties to combat infection, lymphedema, and swelling. Functional reconstruction was then performed in a staged fashion with a free functional muscle transfer using the contralateral gracilis.
上肢近端的高速创伤性截肢对患者来说是毁灭性的，对治疗团队而言也是一项极具挑战性的外科手术。手外科医生必须同时应对血运障碍，及时进行微血管吻合；处理严重污染，进行细致的清创；以及解决截肢问题，实现稳定固定。在恢复一个功能正常的肢体时，许多这些目标相互矛盾。本病例描述了一名23岁男性在摩托车事故中遭受左肱骨截肢后的一种新颖治疗策略。通过旋股外侧动脉进行异位储存来暂时保存截肢的手臂，以便进行彻底清创，并立即进行切开复位内固定钢板治疗，同时采用游离大网膜瓣覆盖，随后进行分层皮片移植。这种策略允许对上臂截肢进行一期治疗，包括立即进行微血管吻合、稳定的内固定以及大网膜提供的软组织覆盖，大网膜具有免疫原性和淋巴管生成特性，可对抗感染、淋巴水肿和肿胀。然后分阶段进行功能重建，采用对侧股薄肌进行游离功能性肌肉转移。
