手指腹部组织块离断再植的临床体会

The clinical experience of replantation of avulsed finger pulp

目的探讨手指腹部组织块离断再植的手术适应证及方法。方法2008年至2012年，对43例45指指腹部组织块离断进行再植。术中指动脉、指腹静脉皆吻合23指；吻合指腹静脉动脉化12指；指动脉静脉化6指，未吻合指腹静脉而行伤口放置皮片、生理盐水点滴4指。结果术后存活36指，成活率为80％。随访25指，11指失访，随访时间为6个月至3年。存活手指组织块外形和功能恢复良好。术后3～9个月，平均6个月，再植组织块逐渐恢复痛、温觉及触觉，皮瓣两点分辨觉达3～7mm。结论手指腹部组织块离断再植存活后外观和功能良好，只要离断的组织块完整且能找到可供吻合的血管应尽量对其进行再植。

Objective To discuss the surgical indications and methods of replantation of avulsed finger pulp. Methods From 2008 to 2010, 43 cases of 45 finger pulp tissue pieces were replanted. The digital artery and volar digital vein were both anastomosed in 23 fingers. In 12 fingers only volar veins were anastomosed for arterialization to perfuse the replants. Converting anastomosed digital artery for venous drainage was done in 6 fingers. The rest 4 fingers did not have anastomosis of the volar veins. Instead venous drainage was achieved by placing a robber drain in the wound which was dripped with normal saline. Results Replants of 36 fingers survived, accounting for an 80% survival rate. Of these 36 survivals, 25 fingers were follow-up while 11 fingers were lost to follow-up. The follow-up time ranged from 6 months to 3 years. Survival fingers all had good appearances and good functional recovery. Pain, temperature and touch sensation were restored to the replants 3 to 9 months postoperatively （average, 6 months）. Two-point discrimination of the pulps reached 3 to 7 mm. Conclusion The function and appearance of the replanted finger pulp are good if the replanted avulsed finger pulp tissue survives. Every effort should be made to replant the avulsed piece when the tissue is intact and there is blood vessel for anastomosis.