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題 名 | Free Flap Reconstruction for Diabetic Foot Lesions=以游離皮瓣重建糖尿病足病灶 |
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作 者 | 洪惠鯤; 李俊達; 孫宗伯; 鄭立福; 王健興; 林志明; 黃介琦; 簡守信; | 書刊名 | 臺灣整形外科醫學會雜誌 |
卷 期 | 20:2 2011.06[民100.06] |
頁 次 | 頁87-95 |
分類號 | 416.413 |
關鍵詞 | 糖尿病足; 游離皮瓣; Diabetic foot; Free flap; Microsurgery; Peripheral arterial occlusive disease; |
語 文 | 英文(English) |
中文摘要 | 背景: 糖尿病足的病灶常因爲伴隨血管及神經病變而使情況惡化。當深層的潰瘍或骨髓炎出現時,積極的清創常導致肌腱或骨頭外露,增加重建的困難。由於近來顯微手術的進步,這樣的傷口能夠成功的使用游離皮瓣來重建。 目的及目標: 這篇研究主要是在評估游離皮瓣對於糖尿病足病灶重建的成果。 材料及方法: 我們回顧了2003年1月至2009年6月間,糖尿病足的病人在佛教慈濟綜合醫院接受游離皮瓣重建手術的病例。比較其皮瓣種類、成功率及併發症比率。 結果: 總共有46位糖尿病足的病人(28位男性及18位女性),使用了48個游離皮瓣來進行重建。病人平均年齡爲52.4歲(27~79歲)。使用了各種不同的游離皮瓣:25個股外側肌皮瓣,10個大腿前外側皮瓣,8個橈前臂皮瓣,2個腹直肌皮瓣,以及股直肌皮瓣、股薄肌皮瓣、外側小腿皮瓣各1個。總共的併發症比率爲41.7%,包括:完全皮瓣失敗(1例),部分皮瓣失敗(2例),傷口感染(9例),植皮失敗(4例),靜脈栓塞(2例),血腫(1例),以及皮瓣根蒂出血(1例)。在肌肉皮瓣組別的感染比例較高(25%),相對於肌皮皮瓣(0%)及筋膜皮瓣組別(11.8%)而言。這些病人中並沒有手術前後死亡的案例發生。術後平均追蹤期間爲15個月(1~59個月)。肢體保留的比率爲97.8%。 結論: 對於適當的病人,糖尿病足的病灶可經由游離皮瓣重建得到不錯的結果,而且併發症比率在可接受範圍。 |
英文摘要 | Background: Diabetic foot lesions are often complicated by angiopathy and neuropathy. If a deep ulcer or osteomyelitis is present, there is often exposure of the underlying bone or tendon after aggressive debridement. Owing to recent advancements in microsurgery, such lesions can now be managed successfully with free flap reconstruction. Aim and Objectives: This study was aimed to evaluate the outcome of diabetic foot salvage using free flap reconstruction. Materials and Methods: Between January 2003 and June 2009, patients with diabetic foot and managed with free flap reconstruction in Buddhist Tzu-Chi General Hospital were reviewed. The flap types, success rate and complication rate were analyzed. Results: Forty-six patients (28 males and 18 females) with diabetic foot were reconstructed with a total of 48 free flaps. The mean age was 52.4 years (range from 27 to 79). The different kinds of free flaps that were used were: 25 vastus lateralis flaps, 10 anterolateral thigh flaps, 8 radial forearm flaps, 2 rectus abdominis flaps, 1 rectus femoris flap, 1 gracilis flap and 1 lateral leg flap. The complication rate was 41.7%. This included: total flap loss (1), partial flap loss (2), wound infection (9), loss of split thickness skin graft (4), venous thrombosis (2), hematoma (1) and pedicle bleeding (1). The infection rate was higher in the free muscle flap group (25%) than in the myocutaneous flap group (0%) or the fasciocutaneous flap group (11.8%). There were no perioperative mortalities. The mean follow-up was 15.0 months (range from 1 to 59). The limb salvage rate was 97.8%. Conclusion: In selected cases, diabetic foot lesions can be managed successfully with free flap reconstruction. There is a good outcome with an acceptable complication rate. |
本系統中英文摘要資訊取自各篇刊載內容。