单纯吻合指动脉的末节断指再植

Simple artery anastomosis of finger distal segment replantation

目的探讨单纯吻合指动脉末节断指再植的方法和疗效。方法回顾分析单纯吻合指动脉的末节断指再植23例25指，按照常规方法行指动脉端端吻合，缺损较多者采用对侧动脉移植后端端吻合，尽量吻合优势侧动脉，期间根据再植指体张力情况予七号针头刺穿皮肤全层放血（针刺放血）。甲床放血停止后，根据组织张力情况继续予七号针头针刺放血，维持2～5d即可建立有效循环。结果25指成活23指，失败2指，患指成活率为92％。患指更换指甲后外形与健侧相比无明显异常且生长良好，指腹饱满，皮色及皮温正常。再植指体运动功能恢复良好，指体远端痛温觉均有不同程度恢复，两点辨别觉为3～6mm。结论单纯吻合指动脉的末节断指再植，缩短再植手术时间，提高成活率，术后外形及功能良好。术后甲床及针刺放血治疗是成功的关键。

Objective To discuss the method and results of the simple artery anastomosis of finger distal segment replantation. Methods The artery anastomosis of the finger distal segment replantation of 25 fingers in 23 cases was retrospectively analyzed. The line digital artery anastomosis was performed in accordance with conventional method. In case there was a severe defect of artery, the anastomosis was performed after the transplantation with the contralateral artery; and the superior side artery was preferred whenever possible. Meanwhile, bloodletting of nail bed was carried out for 2 - 4 days with a No. 7 infusion needle （ bloodletting puncture） according to the tissue tension, and effective blood circulation can be established 2 -5 days after nail-bed bloodletting. Results Twenty-three fingers survived, 2 failed, the survival rate being 92%. The growth and appearance of the nails were satisfactory. Being plumpness, replanted fingers were of healthy color, normal temperature and good function, with 2-PD of 3 - 6 mm. Conclusion Simple artery anastomosis of finger distal segment replantation shortens the operation time and raises survival rate, resulting in satisfactory temperature and function of the replanted fingers. Of the multiple factors for successful surgeries, the post-operational bloodletting by puncture at the nail bed is the key point.