腕部和前臂远端挤压伤后的单阶段血管再造和重建:规程化方法。

IF 1.5 3区 医学 Q3 SURGERY
Microsurgery Pub Date : 2024-07-10 DOI:10.1002/micr.31210
Jianchi Li MD, Xiang Wu MD, Songgen Peng MD, Qiahong Guo MD, Ming Liu MD, Shengshan Li MD, Ellen C. Shaffrey MD, Weifeng Zeng MD, Xianhua Pan MD, PhD, Xuan Liao MD, Hongwei Liu MD, PhD
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引用次数: 0

摘要

背景:由于挤压机制造成的高能量创伤导致手腕或前臂远端截肢后,会出现复杂的组织缺损,使修复和重建工作面临挑战。鉴于这种类型的抢救难度很大,患者的翻修截肢率很高。不过,有报道称,重建成功的患者生活质量更高。在此,我们介绍了一种使用大腿前外侧皮瓣(ALT)进行血管再通和重建的规程化方法,以挽救因挤压机制造成的创伤性截肢后的手部功能:在2016年10月至2023年10月期间,对所有因高能量挤压伤继发腕部或前臂远端截肢后使用ALT进行单阶段紧急清创、血管重建和软组织覆盖的患者进行了回顾性审查。研究人员查看了病历,以了解术前肢体损伤抢救评分、术中详细情况(包括损伤的结构和采用的重建方法)以及术后数据(如随访时间、效果和并发症):11名患者符合纳入标准,平均年龄为35.5(21-49)岁。皮肤软组织缺损的平均大小为 17.3 × 8 厘米(范围:长:13-25 厘米,宽:6-13 厘米),所有病例均伴有下层骨骼、神经和血管损伤。用于重建的 ALT 皮瓣平均大小为 19.2 × 9.8 厘米(长:14-27 厘米,宽:7-15 厘米)。所有患者的再植肢体都能存活。一名患者的皮瓣部分坏死,需要二次清创和植皮。九名患者痊愈后无需再进行任何清创手术。患者平均随访 24.6 (12-38) 个月。所有患者的功能恢复都令人满意,达到了陈氏标准的II至III级:结论:对于腕部外伤性挤压截肢并伴有周围软组织损伤的患者,使用ALT可在一个阶段内完成彻底清创、血管重建和截肢重建。本文介绍了两家医疗机构采用的一种规范化方法,该方法提高了创伤肢体的存活率并减少了并发症,改善了患者的长期预后。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Single-staged revascularization and reconstruction after crush injury of the wrist and distal forearm: A protocolized approach

Background

Amputation of the wrist or distal forearm after high-energy trauma due to a crushing mechanism is associated with complex tissue defects, making repair, and reconstruction challenging. Given the difficulty of this type of salvage, patients unfortunately experience a high revision amputation rate. However, a higher quality of life has been reported in patients with successful reconstructions. Herein, we described a protocolized approach for revascularization and reconstruction for functional hand salvage after traumatic amputation from a crushing mechanism using an anterolateral thigh flap (ALT).

Methods

A retrospective review was performed between October 2016 and October 2023 for all patients who underwent single-stage emergent debridement, revascularization, and soft tissue coverage using the ALT after amputation at the level of the wrist or distal forearm secondary to high-energy crush injury. Charts were reviewed for the preoperative Mangled Extremity Salvage Score, intraoperative details including what structures were injured and the reconstructive method performed, and postoperative data such as follow-up duration, outcomes, and complications.

Results

Eleven patients met the inclusion criteria with an average age of 35.5 (21–49) years old. The average size of the skin soft tissue defects was 17.3 × 8 cm (range, length: 13–25 cm, width: 6–13 cm), and all cases had associated injury to the underlying bone, nerves, and blood vessels. The average size of the ALT flap used for reconstruction was 19.2 × 9.8 cm (range, length: 14–27 cm, width: 7–15 cm). All patients had survival of the replanted limb. One patient experienced partial flap necrosis that required secondary debridement and skin graft. Nine patients healed without requiring any additional debridement procedures. Patient follow-up averaged 24.6 (12–38) months. All patients achieved satisfactory functional recovery with Grade II to III of Chen's criteria.

Conclusions

For patients with traumatic crush amputation to the wrist with surrounding soft tissue injury, thorough debridement, revascularization, and reconstruction of amputated limbs can be performed in a single stage using the ALT. A protocolized approach from two institutions is presented, demonstrating improved survival and reduced complications of the traumatized limb with improved long-term patient outcomes.

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来源期刊
Microsurgery
Microsurgery 医学-外科
CiteScore
3.80
自引率
19.00%
发文量
128
审稿时长
4-8 weeks
期刊介绍: Microsurgery is an international and interdisciplinary publication of original contributions concerning surgery under microscopic magnification. Microsurgery publishes clinical studies, research papers, invited articles, relevant reviews, and other scholarly works from all related fields including orthopaedic surgery, otolaryngology, pediatric surgery, plastic surgery, urology, and vascular surgery.
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