断指再植23例分析

Analysis of digital replantation in 23 cases

目的探讨手指离断再植的原则,方法和综合治疗措施,提高断指再植的成活率。方法回顾分析12年施行的断指再植手术23例。不全离断有皮蒂相连只吻合一根指动脉。完全离断末节吻合一根指动脉;中节动-静脉比例1:1,近节动-静脉比例1:2。术后“三抗”治疗。结果23例共28指离断,20指完全离断,18指成活,1指大部成活,1指失败。成活率92.5%。8指不全离断,全部成活。结论无创操作和显微缝合技术是再植成功的前提;术后严密观察及“三抗”治疗是提高再植指成活率的关键。早期康复训练是实践功能再植的有效手段。

Objective: To study the principles, methods and synthetic measures of digital replantation to improve the survival rate of replanted digits. Methods: 28 replantation digits from 23 cases in 12 years were reviewed and analysed. For incomplete severed digits with skin flap connetion, one artery was anastomosed. For complete severed digits, one artery was anastomosed at fingertip, the ratio of anastomosis for artery and veins was 1 vs 1 at the middle and 1 vs 2 at the proximal of digit. The '3-anti' treatment were carried out postoperatively. Results: Among 28 severed digits from 23 cases, 18 replantation digits survived, 1 survived mostly and 1 failed among 20 complete svered digits from 16 cases. Survival rate was 92.5%. 8 incomplete severed digits from 7 cases survived. Conclusions: Microsurgical skills and small vessel anastomosis techniques are the premise of replantatioin. Survival of replanted digits depends on careful observation and '3-anti' treatment postoperatively. Early function exercise plays an important role in functional recovery of replanted digits.