吻合掌侧静脉及保留指甲的指尖再植

Fingertip replantation with anastomosis of palm vein and retaining the nail

目的:探讨手指指尖离断的治疗方法及临床效果。方法:2007年10月至2011年6月治疗13例18指指尖离断患者,其中男9例,女4例;年龄17～45岁,平均26岁。伤后至就诊时间30min～5h,断指缺血时间1.5～7h,均为常温保存。采用吻合掌指静脉及保留指甲的方法进行再植。结果:13例18指断指均成活并获随访,术后无血管危象发生。随访时间为3～24个月,平均14个月。患指外形及长度与健指相似,指甲平整,关节活动良好,触、痛觉恢复,两点辨别率3～6mm,平均5mm。根据中华医学会手外科学会断指再植功能评定标准评定,优14指,良3指,差1指。结论:采用吻合掌侧静脉及保留指甲的方法进行指尖再植,不仅可以提高断指成活率还可以恢复良好的外观及功能。

Objective：To study the replantation methods and clinical results of amputated fingertip. Methods：From October 2007 to June 2011,18 fingers of 13 cases were replanted with anastomosis of palm vein and retaining the nail , including 9 males and 4 females,with an average age of 26 years old ranging from 17 to 45 years old. The time from injury to therapy was from 30 min to 5 h, time of broken finger ischemia was from 1.5 to 7 h. All broken fingers were preservation under normal tem- perature. Results： All fingers were survived, no vascular crisis happened. All cases were followed up from 3 to 24 months with an average of 14 months. The length and shape of replanted fingers were similar to that of the healthy side. The new nails were smooth, the function was perfect,the sense of pain and touched sensation had been recovered. Their two piont discriminations ranged from 3 to 6 mm with an average of 5 mm. According to the assessment standard of Chinese Medical Association of Hand Surgery,the results were excellent in 14 cases,good in 3 cases,poor in 1 case. Conclusion：Fingertip replantation with anasto-mosis of palm vein and retaining the nail is regained satisfactory appearance and function of the digits with a high survival rate.