Ciresi K F, Anthony J P, Hoffman W Y, Bowersox J C, Reilly L M, Rapp J H
Division of Plastic and Reconstructive Surgery, University of California San Francisco 94143-0932.
J Vasc Surg. 1993 Oct;18(4):648-53; discussion 653-5. doi: 10.1067/mva.1993.48582.
Large ischemic wounds, particularly with exposed bone or tendons, may not heal even after successful revascularization. We have taken an aggressive approach for limb salvage that uses autogenous vein grafting and simultaneous microvascular free tissue transfer.
In the past year, seven patients (average age 67 years; range 56 to 79) with ischemic disease and distal ulceration underwent revascularization for limb salvage and free tissue transfer. Each had a nonhealing wound (average size 80 cm2), present for 8.6 months (range 2 to 24 months). Simultaneous vein bypass and free tissue transfer was performed in four (57%) of the seven patients.
All flaps were initially viable; however, one was lost on day 4 because of hypotension and congestive heart failure. One patient with a successful flap died at 1 month of pneumonia. Minor wound complications were seen in four (57%) of seven patients. Five of the seven patients had the wounds heal completely and are ambulatory at an average follow up of 10 months.
Our aggressive approach was successful in preserving limb length and function in 71% of our patients. We perform simultaneous procedures whenever possible to minimize operative and hospitalization times. We believe that this combined approach optimizes the treatment of ischemic limbs with large ulcers.
大面积缺血性伤口，尤其是伴有骨骼或肌腱外露的伤口，即使在成功进行血管重建后也可能无法愈合。我们采取了积极的保肢方法，采用自体静脉移植和同期微血管游离组织移植。
在过去一年中，7例（平均年龄67岁；范围56至79岁）患有缺血性疾病和远端溃疡的患者接受了血管重建以保肢并进行游离组织移植。每例患者均有一个不愈合的伤口（平均面积80平方厘米），已存在8.6个月（范围2至24个月）。7例患者中有4例（57%）同时进行了静脉搭桥和游离组织移植。
所有皮瓣最初均存活；然而，1例因低血压和充血性心力衰竭在第4天皮瓣坏死。1例皮瓣移植成功的患者在1个月时死于肺炎。7例患者中有4例（57%）出现轻微伤口并发症。7例患者中有5例伤口完全愈合，平均随访10个月时可行走。
我们积极的方法在71%的患者中成功地保留了肢体长度和功能。我们尽可能同时进行手术以缩短手术时间和住院时间。我们认为这种联合方法优化了对伴有大面积溃疡的缺血肢体的治疗。
