Experiences in the Treatment of Symmetrical Peripheral Gangrene

對稱性週邊壞疽之治療經驗

陳盈婷(Ying-Ting Chen) ； 吳孟熹(Meng-Si Wu) ； 鄭立福(Li-Fu Cheng) ； 李俊達(Jiunn-Tat Lee)

《臺灣整形外科醫學會雜誌》 31卷3期 (2022/09) Pp. 143-154

摘要

Background: Symmetrical peripheral gangrene is an uncommon phenomenon caused by an underlying critical medical problem. It is characterized by the sudden onset of symmetrical gangrene of two or more acral parts of the body without evidence of large vessel occlusion or vasculitis. The amputation rate is high among the survivors. Aim and Objectives: This study describes several cases of symmetrical peripheral gangrene and details the clinical profile, etiological factors, and outcome of these patients. Materials and Methods: Patients with symmetrical peripheral gangrene who were seen at our institution from January 2001 to January 2019 were included. A retrospective chart review was performed to identify the clinical course and risk factors. In addition, we describe our experiences in the management of symmetrical peripheral gangrene in the acute and late stages. Results: Eleven patients (four men and seven women) were diagnosed with symmetrical peripheral gangrene. The median age was 66 years. The most common cause was an infectious disease. Seven patients (63.6%) used vasopressors. Six patients (54.5%) had disseminated intravascular coagulation (DIC). A large vessel occlusion was ruled out in all patients by handheld Doppler and palpable pulses. The mortality rate was 45.5%. Three survivors underwent free flap reconstruction for foot defects after varying degrees of amputation. All flaps survived and the three patients could stand or walk after reconstruction. Conclusion: In this study, we describe our treatment and detail the outcomes of patients with symmetrical peripheral gangrene. Symmetrical peripheral gangrene is accompanied with a high mortality and amputation rate. However, free flap reconstruction is an effective way to preserve the extremity length and function as much as possible. We believe that our study makes a contribution to the literature because we illuminate the possible approaches in the management of patients with symmetrical peripheral gangrene.

關鍵字

symmetrical peripheral gangrene ； disseminated intravascular coagulation ； limb amputation ； free flap

並列摘要

背景：對稱性週邊壞疽是一種不常見的疾病，特徵是突發性的壞疽出現在兩個或兩個以上的肢體末端，並且要排除大血管阻塞以及血管炎的問題。對稱性週邊壞疽常常是由其他潛在的嚴重問題所導致的。目的及目標：這項研究的目的是去辨認對稱性週邊壞疽的臨床表現，病因，治療和結果。材料及方法：我們將2001年1月至2019年1月出現對稱性週邊壞疽的病人納入此研究，並排除有大血管阻塞及血管炎問題的病人。我們進行了回溯性研究，去辨認對稱性週邊壞疽的臨床病程及危險因子。同時也紀錄了我們處理的流程，後續接受的手術以及功能結果。結果：總共有11位病人納入我們的研究，包含4位男性及7位女性，年齡中位數是66歲。所有病人都是感染的原因造成的，有6位病人在壞疽出現前有瀰漫性血管內凝血（54.5％），7位病人有使用升壓劑（63.6％）。我們利用杜卜勒和觸診脈搏搏動排除了大血管阻塞。最後有5位病人死亡（45.5％），而6位存活的病人在狀況穩定後接受了不同程度的截肢手術，其中有三位病人接受了游離皮瓣手術重建肢體，這三位病人在後續追蹤時都能夠行走或站立。結論：在這個研究中，我們描述了對於對稱性週邊壞疽治療的流程及成果。稱性週邊壞疽是一種影響很大的疾病，伴隨有高死亡率，即使存活，後續仍有高比例需要截肢。然而，游離皮瓣手術對於保留肢體的長度及功能是個很有效的方法，相信我們的研究後續對稱性週邊壞疽的治療有所幫助。