Betz A M, Stock W, Hierner R, Baumgart R
Klinikum Innenstadt, Ludwig-Maximilians-Universität, München, Germany.
Microsurgery. 1993;14(7):446-53. doi: 10.1002/micr.1920140706.
Multiple secondary grafting procedures may be necessary in cases of complete or partial amputation of the lower limb if the aim is to preserve the initial limb length. The traditional concept of staged reconstruction often leads to a prolonged hospitalisation and a high complication rate, especially in cases with segmental nerve defects of more than one major nerve and severe skin loss. To minimize multiple secondary operations of soft tissue and bone, we have developed the concept of primary shortening with secondary limb lengthening. We perform a primary shortening of the amputation stump and the severed limb at the time of replantation, in order minimize the skin defect and to undertake a primary wound closure and/or primary nerve suture. Six to 12 months after replantation, secondary limb lengthening is started, using an external or internal distraction device. Since 1985, 7 patients presenting with complete or partial amputation of the lower leg had been treated using this concept. The indications, operative technique, complications and results are shown and discussed, comparing this new concept to the traditional concept with extensive free soft tissue transfer and secondary nerve grafting.
如果目的是保持初始肢体长度，对于下肢完全或部分截肢的病例，可能需要多次二期移植手术。分期重建的传统观念常常导致住院时间延长和并发症发生率高，尤其是在存在一条以上主要神经的节段性神经缺损和严重皮肤缺损的病例中。为了尽量减少软组织和骨骼的多次二期手术，我们提出了一期缩短并二期肢体延长的概念。在再植时，我们对截肢残端和离断肢体进行一期缩短，以尽量减少皮肤缺损，并进行一期伤口闭合和/或一期神经缝合。再植后6至12个月，使用外部或内部牵张装置开始二期肢体延长。自1985年以来，已有7例小腿完全或部分截肢的患者采用了这一概念进行治疗。展示并讨论了其适应证、手术技术、并发症及结果，并将这一新概念与采用广泛游离软组织移植和二期神经移植的传统概念进行了比较。
