Park Bo Young
Department of Plastic and Reconstructive Surgery, School of Medicine, Ewha Womans University, Seoul, Republic of Korea.
Plast Reconstr Surg Glob Open. 2025 Mar 3;13(3):e6564. doi: 10.1097/GOX.0000000000006564. eCollection 2025 Mar.
Peripheral gangrene, caused by various etiologies, including diabetes, peripheral artery disease, trauma, and vasopressor use, poses significant challenges. Traditional management often involves proximal amputation, which carries a high risk of major amputation and mortality. This study evaluated the efficacy of perforator flaps for toe preservation in patients with toe necrosis.
Six patients with peripheral gangrene, affecting a total of 9 toes, were retrospectively analyzed. The surgical procedure entailed only soft tissue debridement with minimal to no bone amputation and subsequent coverage using thin perforator flaps. Patient demographics, surgical details, flap outcomes, and additional procedures were also reviewed.
Despite potential technical challenges, all but 1 flap survived, with 1 patient requiring partial flap loss management using a full-thickness skin graft. Most patients exhibited successful infection control and wound healing, with a significant emphasis on preserving toe functionality and length.
This study demonstrated that toe preservation with "encircling" perforator flaps is a viable alternative to traditional proximal amputation for patients with peripheral gangrene. This approach may provide a potential benefit in preserving limb length, but careful patient selection and surgical precision are paramount for achieving favorable outcomes.
由包括糖尿病、外周动脉疾病、创伤和使用血管升压药在内的各种病因引起的外周坏疽带来了重大挑战。传统治疗通常涉及近端截肢，这具有较高的大截肢和死亡风险。本研究评估了穿支皮瓣在足趾坏死患者中保留足趾的疗效。
回顾性分析6例外周坏疽患者，共累及9个足趾。手术过程仅包括软组织清创，极少或不进行骨截肢，随后使用薄穿支皮瓣覆盖。还回顾了患者的人口统计学资料、手术细节、皮瓣结果和其他手术。
尽管存在潜在的技术挑战，但除1例皮瓣外其余均存活，1例患者需要使用全厚皮片处理部分皮瓣丢失。大多数患者感染得到成功控制，伤口愈合良好，重点是保留足趾功能和长度。
本研究表明，对于外周坏疽患者，采用“环绕”穿支皮瓣保留足趾是传统近端截肢的一种可行替代方法。这种方法可能在保留肢体长度方面具有潜在益处，但仔细的患者选择和手术精度对于取得良好结果至关重要。
