Serletti J M, Deuber M A, Guidera P M, Herrera H R, Reading G, Hurwitz S R, Jones J A, Ouriel K, Green R M
Department of Orthopaedic Surgery, University of Rochester School of Medicine, N.Y., USA.
Plast Reconstr Surg. 1995 Oct;96(5):1136-44. doi: 10.1097/00006534-199510000-00022.
Atherosclerosis of the lower extremity frequently leads to limb-threatening ischemic soft-tissue wounds. Over the past 44 months, 30 selected patients with arterial disease documented by angiography were treated with combined vascular reconstruction and free-tissue transfer for limb salvage. Soft-tissue defects occurred on the plantar and dorsal surfaces of the foot and distal tibia with significant bone, tendon, or joint exposure. Thirteen patients had osteomyelitis. Eighteen patients underwent simultaneous soft-tissue and vascular reconstruction, while 12 patients underwent delayed soft-tissue reconstruction. The free-flap tissues included the rectus abdominis flap in 13, the latissimus dorsi flap in 7, the radial forearm flap in 5, the scapular flap in 3, and the omentum flap in 2. Autogenous venous bypass was performed to the popliteal segment in 6 patients and the infrapopliteal arteries in 18. Five patients had inadequate outflow for complete vascular reconstruction and were treated with proximal vein grafts directed into the free flap. Twenty-two patients (73 percent) had successful free-tissue transfer and bypass graft patency and were independent ambulators over the mean follow-up period of 22 months. Of the 8 unsuccessful reconstructions, 3 patients had early free-flap and graft failure. Five patients developed new areas of ischemic disease despite graft and flap patency. All 8 patients were treated with amputation; 7 never regained ambulation. The combined application of vascular and free-flap soft-tissue reconstruction for the threatened ischemic lower extremity has produced excellent functional results in the majority of our patients.
下肢动脉粥样硬化常导致威胁肢体的缺血性软组织伤口。在过去44个月中，30例经血管造影证实患有动脉疾病的患者接受了血管重建和游离组织移植相结合的治疗，以挽救肢体。足部跖面和背面以及胫骨远端出现软组织缺损，伴有明显的骨、肌腱或关节外露。13例患者患有骨髓炎。18例患者同时进行了软组织和血管重建，12例患者进行了延迟软组织重建。游离皮瓣组织包括13例腹直肌皮瓣、7例背阔肌皮瓣、5例桡侧前臂皮瓣、3例肩胛皮瓣和2例大网膜皮瓣。6例患者对腘动脉段进行了自体静脉搭桥，18例患者对腘动脉以下动脉进行了搭桥。5例患者因流出道不足无法进行完全血管重建，接受了近端静脉移植至游离皮瓣的治疗。22例患者（73%）游离组织移植成功且搭桥血管通畅，在平均22个月的随访期内能够独立行走。在8例重建失败的患者中，3例患者早期出现游离皮瓣和移植失败。5例患者尽管移植血管和皮瓣通畅，但仍出现了新的缺血性疾病区域。所有8例患者均接受了截肢治疗；7例患者再也无法行走。血管和游离皮瓣软组织重建联合应用于治疗受到威胁的缺血性下肢，在我们大多数患者中产生了优异的功能结果。
