复杂肢(指)体组织及器官离断伤救治研究

Studies on the treatment of the complex and special amputated injuries for the extremities and tissues/organs

目的探讨有关特殊类型肢(指)体组织及器官离断损伤的显微再植和修复方法。方法回顾分析了合并复合组织缺损的肢体离断伤再植修复72例,多肢体离断再植19例40侧肢体,多指多节段离断再植26例63节段,双手十指离断再植4例,复合组织离断再植59例,70岁以上高龄肢体离断5例以及特殊器官离断伤11例。采用原位再植、交叉再植、组织移植等显微外科技术进行修复。结果对其中162例患者随访3个月～10年,功能恢复情况为上肢:优27例,良35例,差12例,优良率83.8%;下肢:优33例,良34例,差11例,优良率85.9%。外耳再植成活5例,皮瓣修复重建耳廓2例全部成活,阴茎及睾丸再植2例全部成活,舌体再植1例失活,鼻离断再植1例失活。结论对特殊组织器官离断损伤,采用原位再植、交叉再植、寄养再植、皮瓣转移、组织移植等显微重建方法进行修复可使损伤组织器官恢复原有的外形和功能。

Objective The aim of the present study is to discuss the replantatiou and repairing methods for the complex amputated injuries of the extremities and the specified tissues/organs. Methods A total of 196 cases were retrospectively analyzed, including 72 cases on the replantatiou and repair for the amputated extremities with tissue defects, 19 cases （40 extremities）on the replantation for the multiple amputated extremities,26 cases（63 segments）on the replantation for multiple fingers and multiple segments amuputation ,4 on the amputated injury, of bilateral hands,59 on the replantation for the amputated injuries of composite tissues,5 on the amputated extremities in elderly more than 70 years old and 11 cases on the special amputated injury of organs. These injuries were repaired with microsurgery techniques, such as orthotopic and cross replantation, tissue transplantation and so on. Results The minimum followup was 3 months and maximum is 10 years in 162 patients. The outcome of functional recovel7 for the upper extremity as follows： excellent： 27 cases, good： 35 cases, poor： 12cases, fine rate： 83.8% ; for the lower extremity： excellent：33 cases, good：34 cases, poor： 11 cases, fine rate：85.9%. There were success in 5 cases for external ear replantation,2 for earflap reconstruction with flap, and 2 for replantation of penis and testicle, while failure in 1 case for external ear temporary ectopic implantation, 1 for tongue replantation and 1 for replantation of amputated nose. Conclusions For the amputated injuries of those special tissues and organs, the shape and function of amputated tissues and organs can be well reestablished by microsurgery replantation, orthotopic and cross replantation,temporary ectopic implantation, reconstruction by flap transfer, tissue transplantation.