指尖套脱性离断再植

Replantation of degloved fingertips

目的探讨指尖套脱性离断再植的手术适应证及方法。方法2005年至2009年，对14例21指指尖套脱性断指进行再植。术中吻合指动脉21指；吻合指腹静脉7指，指动脉静脉化2指，未吻合指腹静脉而行伤口放置皮片、生理盐水点滴12指。结果术后20指存活，1指坏死，成活率为95．2％。随访9例15指（5例失访），随访时间为4个月至4年。再植手指外形和指甲生长良好，关节活动度正常。指端两点分辨觉平均为4mm。结论指尖套脱性离断指体再植后功能恢复良好，不论是否吻合静脉，只要有可供吻接的动脉应尽量对其进行再植。

Objective To investigate the surgical indications and techniques of fingertip replantation in degloving injuries. Methods From 2005 to 2009, 21 finger tips with degloving injury in 14 cases were replanted. Reperfusion of the replants was achieved by digital artery anastomosis in all 21 fingers. Venous drainage was handled by anastomosis of finger pulp vein in 7 fingers, vein-to-digital artery anastomosis in 2 fingers, and wound drainage with a rubber drain and saline in-igation without vein anastomose in 12 fingers. Results Twenty fingers survived while one finger necrosed. The survival rate was 95.2%. Nine cases with 15 fingers were follow-up for 4 months to 2 years. The appearance of the replanted fingers, especially the finger nail, was satisfactory. Range of motion of the distal interphalangeal joints was normal. 2-point discrimination averaged 4 mm. Conclusion Replantation of degloved fingertips leads to good functional recovery. Replantation should be attempted whenever there is anastomoseabled artery, regardless of the vein conditions.