Holloway G A, Burgess E M
Surg Gynecol Obstet. 1978 May;146(5):750-6.
Twenty-six patients undergoing below the knee amputation for ischemic disease of the lower part of the leg had skin blood flow determinations made at the level of the amputation. Flow was measured using the 133Xe clearance technique preoperatively as well as at four and eight weeks after amputation. Amputation was performed using the standard long posterior flap technique, and patients were treated with either an immediate postoperative prosthetic fit or a controlled environment treatment system. Healing occurred primarily in 19 patients; a local below the knee revision was required in two and an above the knee revision in one patient. Flow was lower than in the nondiseased control group in almost all instances preoperatively, but no definite level below which healing would not occur was identified. Postoperatively, skin flow increased in all instances and had reached levels equal to that for the normal control group by eight weeks or sooner. This suggests that, in many instances of nonhealing, local below the knee revisions may be successful without requiring the higher above the knee procedure. No significant differences were noted between patients with diabetes and those without diabetes or either method of postoperative treatment in terms of healing or cutaneous flow.
26例因小腿缺血性疾病接受膝下截肢手术的患者，在截肢平面进行了皮肤血流测定。术前以及截肢后四周和八周，使用133Xe清除技术测量血流。采用标准的长后皮瓣技术进行截肢手术，患者术后接受即时假肢适配或可控环境治疗系统治疗。19例患者主要实现愈合；2例患者需要进行局部膝下翻修，1例患者需要进行膝上翻修。术前几乎所有情况下血流均低于无疾病对照组，但未确定愈合不会发生的明确血流水平。术后，所有情况下皮肤血流均增加，到八周或更早时已达到正常对照组的水平。这表明，在许多不愈合的情况下，局部膝下翻修可能成功，而无需进行更高难度的膝上手术。在愈合或皮肤血流方面，糖尿病患者与非糖尿病患者之间以及两种术后治疗方法之间均未发现显著差异。
