毁坏性断掌再植与功能重建

Replantation and functional reconstruction of mutilating injury of the palms

目的扩大毁坏性断掌再植的适应证，提高再植肢体功能恢复的效果。方法１９７９～１９９６年，根据伤情特点和重建手功能的要求，通过４种术式再植毁坏性断掌２３例：（１）２个断指移位再植于前臂残端；（２）２或３个断指移位再植于腕部；（３）５个手指全部移位再植于前臂残端；（４）示指移位再植于第１掌骨基底，修整第２掌骨形成虎口，其余３个手指分别再植于第３、４、５掌骨近端残端。结果２３例断掌再植后全部成活。５例经１年以上随访，综合评定手功能，平均失能值为３２％。结论许多严重毁坏的断掌，不仅可以再植成活。

Objective To expand the indications of replantation of mutilated palms and improve the functional outcome. Methods 23 cases of mutilated palms were replanted from 1979 to 1996. Four types of replantation techniques were designed: (1) Two severed fingers were heterotopically replanted to the stump of the forearm; (2) Two or three fingers were heterotopically replanted to the wrist; (3) Five fingers were replanted to the stump of the forearm; (4) The index finger was replanted to the base of the first metacarpal, the second metacarpal was incised to form the first web and the other 3 fingers were replanted to the third, forth and fifth metacarpal. Results The reconstructed fingers survived in all the 23 cases. Five patients were followed up for over 1 year. Comprehensive evaluation of the hand function revealed a 32% failure rate. Conclusions Mutilated palms can be salvaged by heterotopic replantation and the functional result is good.