重度四肢外傷の治療方針～私が実践している，より安全に治療するための工夫～

抄録

  The history of strategic treatment for severe extremity trauma began with Godina’s study in 1986. In Japan, standardization of severe extremity trauma treatment has progressed since the publication of the Japan strategy in 2017 by Tsuchida. Satisfactory results are expected in many cases with prompt treatment at specialized facilities.　
  Although the severity and patient background vary from case to case, the important points that must be cleared for smooth treatment are “infection” and “skin flap troubles,” which can be prevented by “adequate debridement” and “reliable bone and soft tissue reconstruction” according to the strategy.　
  At our institute, we take the following measures. After debridement, we perform CLAP therapy to prevent infection. Before soft tissue reconstruction, we confirm the zone of injury using ultrasound to select the site where vascular anastomosis can be safely performed. During the reconstruction, we check the presence of fibrosis around the recipient’s vessels and the patency of the vessels. We perform end-to-side vascular anastomosis whenever possible, and consideration is given to both the flap and the recipient’s condition. After the reconstruction, TcpCO₂ is monitored for real-time objective evaluation of flap blood flow.