小儿指尖断指再植

REPLANTATION OF SEVERED FINGER TIP IN CHILD

目的：回顾性分析小儿指尖断指再植的疗效。方法：山东烟台１０７医院１９８７～１９９３年再植完全性指尖断指２４例２７指，１５～１２岁。其中刀切伤４例，挤切伤１７例，兔咬伤３例，拇指７指，食指１２指，中指６指，断离水平位于甲弧处２１指，甲中段处６指。手术顺序从掌侧皮肤开始，依次为皮下静脉，指神经，再固定骨闭合伤口。甲弧处吻合指动、静脉，甲中段处只吻合动脉，术中只用橡皮筋阻断手指血供，不用血管夹，找静脉的方法是按解剖部位找，按掌侧静脉优势侧去找，静脉壁极薄紧贴于真皮深面，可见皮下出血点或挤压指尖将残留的血液挤出或吻合动脉后指尖静脉出血。结果：成活２６指（９６．３％），随访１２～３６个月指甲生长正常，指尖与健侧相等，两点辨别觉达２～３ｍｍ。结论：小儿指尖的再植成功，其功能恢复是所有断指再植中最好的一组。

Objective:To retrospect and analyze the curative result of replantation of severedfinger tip in child(RSFTC).Methods:27 finger tips on 24 children were replanted from 1987 to 1993in our hospital.There were of 7 thumbs,12 indexes,and 6 median digiti. The orders of the replanta-tion were subcutaneous veins,artery,nerve,fixation of bone and closure of wound in turn.The bloodsupply to the finger were stopped with a rubber sling instead of vessel clips during the operation. Re-sults:26 fingers were survived.The growth of finger nail were normally after 12 to 36 months’follow-up. The two point discriminations were 2 to 3 mm. Conclusions:RSFTC can succeed and it’s function-al recovery is the best one among all the replanted fingers.