Hierner R, Betz A M, Comtet J J, Berger A C
Clinic for Plastic, Hand, and Reconstructive Surgery Burn Center, Hanover Medical Center, School of Medicine, Germany.
Microsurgery. 1995;16(12):830-9. doi: 10.1002/micr.1920161211.
As a result of modern therapeutic and technological advances, the surgeon has the ability to salvage even the most severely injured lower limbs. However, the success of replantation nowadays is no longer measured simply on the basis of restoration of viability but also on functional outcome compared with primary amputation with early prosthetic fitting, the risk to the patient during and after replantation and the overall time of treatment which should not exceed 2 years. Although every major limb replantation has to be considered individually, the decision-making process for reconstruction (replantation/revascularisation) versus amputation with subsequent early prosthetic fitting should be determined by objective criteria. Based on personal experience and an extensive literature search, an algorithm for treatment of amputation or amputation-like injuries to the lower leg has been developed and tested in a clinical study. A 100% viability success rate was achieved. There was not only a significant increase in the percentage of "functional extremities" but also a doubling in grade I results. Moreover, there was a 50% reduction in patients presenting a "non-functional extremity", and no patient required a secondary re-amputation. The replantation risk (e.g., risk of severe systemic disturbance during and/or after replantation) was about 16.6% (2/12) in our study. There was a significant decrease in the postoperative complication rate and no patient died during or after replantation. Based on our experience, if reconstruction in subtotal or total lower leg amputation is done for a well-selected patient group, good functional results with a reasonable replantation risk and a reasonable time for social re-integration can be achieved.
由于现代治疗方法和技术的进步，外科医生甚至有能力挽救损伤最严重的下肢。然而，如今再植手术的成功不再仅仅以恢复肢体活力来衡量，还包括与早期安装假肢的一期截肢相比的功能结果、再植手术期间及术后对患者的风险以及总治疗时间（不应超过2年）。尽管每例主要肢体再植都必须单独考虑，但重建（再植/血管重建）与截肢并随后早期安装假肢的决策过程应由客观标准决定。基于个人经验和广泛的文献检索，我们制定了一种小腿截肢或类似截肢损伤的治疗算法，并在一项临床研究中进行了测试。实现了100%的存活成功率。不仅“功能良好的肢体”百分比显著增加，而且Ⅰ级结果翻倍。此外，出现“无功能肢体”的患者减少了50%，且没有患者需要二次截肢。在我们的研究中，再植风险（例如，再植期间和/或之后发生严重全身紊乱的风险）约为16.6%（2/12）。术后并发症发生率显著降低，且没有患者在再植期间或之后死亡。根据我们的经验，如果为精心挑选的患者群体进行小腿次全或全截肢的重建手术，可获得良好的功能结果，再植风险合理，社会重新融入的时间也合理。
