Tomaino M, Bowen V
Department Surgery, Toronto Hospital, University of Toronto, Ont.
Can J Surg. 1995 Jun;38(3):221-8.
The authors review the principles of reconstructive surgery for lower limb salvage after severe lower limb trauma to determine factors that have been used as decision-making criteria for limb salvage or amputation in severe lower extremity injuries and the methods of reconstruction and their outcome. The use of scoring systems and their value in acute decision making (primary amputation or limb salvage) are described. Soft-tissue reconstructive techniques, with emphasis on the use of flaps and the importance of selecting the best technique and time for the reconstruction are reviewed. Skeletal reconstructive techniques are described, including available options and currently held views on indications and use of the best contemporary methods. It is essential for the physician to make a good initial decision on the need for primary amputation or limb salvage. A multidisciplinary approach is fundamental to successful salvage.
作者回顾了严重下肢创伤后下肢挽救重建手术的原则，以确定在严重下肢损伤中用作肢体挽救或截肢决策标准的因素、重建方法及其结果。描述了评分系统的使用及其在急性决策（一期截肢或肢体挽救）中的价值。回顾了软组织重建技术，重点是皮瓣的使用以及选择最佳重建技术和时间的重要性。描述了骨骼重建技术，包括可用的选择以及当前对当代最佳方法的适应症和使用的观点。医生对一期截肢或肢体挽救的必要性做出良好的初始决策至关重要。多学科方法是成功挽救的基础。
