逆行法再植足趾

Retrograde replantation for repair amputated toes

目的 探讨逆行法足趾再植的特点及其效果。方法 从 1991年～ 1999年 ,对 19例 (2 5趾 )离断足趾进行再植 ,再植时保持患足背伸 90°～ 12 0° ,逆行法再植的顺序 :趾底皮肤→趾底皮下静脉→趾固有神经→趾固有动脉→屈趾肌腱→单根克氏针固定趾骨→趾伸肌腱→趾背动脉→趾背皮下静脉→两侧及背侧皮肤。结果 2 5趾中 2 3趾成活 ,成活率 92 % ,患趾总屈曲度 ,趾为 2 5°～ 70° ,第 2、 3趾为 35°～ 90° ,断趾外形恢复良好 ,趾尖两点辨别觉 10mm～ 16mm ,患者行走步态正常 15例 ,基本正常 4例。结论 离断足趾再植极大减轻了病人伤残率 ,功能及外观恢复满意 。

Objective To investigate the character and the effect of severed toes replantation.Methods Twenty five completely severed toes in nineteen cases had been replanted since 1991.Injuried feet were kept in extending at 90°～120° position.The sequence of toe replantation was opposed to the classical order and was so called'the retrograde replantating means(RRM)'.The order of RRM was defined as follow:skin of toe abdomen→subcutaneous vein of toe abdomen→inhered toe nerve→inhered toe artery→flexor toe tendon→toe fixation by a single K needle→extendor toe tendon→artery in the back of toe→subcutaneous vein of toe back→skin of bilateral and back.Results Twenty three of twenty five toes survived replantation(92%).The total flexion degree in replanted halluces was 25°～70°,in the second and the third toe 35°～90°.The appearance of amputated toes restored well.The two point discrimination was 10mm～16mm.Fifteen cases walked as entirely usually in gait,and 4 cases had basic normal gait.Conclusion Replantation of severed toes could alleviate wound greatly.The recovery of foot function and aspect of replanted toes was satisfactory.The RRM gradation showed a distinctive advantage that there was no requirement for injuried foot be moved during operation.