一侧指动脉阻断在末节断指再植中的应用

Application of blocking one side of the finger artery in replantation of distal severed finger

目的 探讨阻断一侧中节近端指动脉联合肝素钠棉球甲床湿敷在甲根部无法建立静脉回流的末节断指再植中的应用和疗效。方法 自2014年12月至2017年11月,我们收治10例甲根部平面完全离断患者,采用阻断一侧中节近端指动脉联合肝素钠棉球甲床湿敷的方法建立静脉回流促进再植指体存活。在吻合双侧的指动脉后结扎非优势侧中节近端指动脉,通过血管压力差原理,优势侧指动脉血经动脉弓一部分营养再植指体,一部分流向非优势侧,在中节经毛细血管进入静脉系统,后期正常静脉系统形成。结果 术后10例再植指体均存活,随访时间为3~15个月,平均10个月。再植指体指甲生长良好,无畸形,指体稍萎缩,感觉恢复至S2-S3+。按中华医学会手外科学会断指再植功能评定试用标准评定:优8例,良1例,可1例。患者对指体的外形及功能满意。结论 对于一些离断指体挫伤较重、静脉回流难以建立的患者,应用阻断一侧中节近端指动脉联合肝素钠棉球甲床湿敷可以有效提高再植指体成活率,是一种简单而有效的方法。

Objective To explore the application and clinical efficacy of blocking one side of the proximal middle segment digital artery combined with wet dressing of heparin sodium cotton on the nail bed in replantation of distal severed finger,at the nail root of which venous drainage cannot be established. Methods From December2014to November2017,10patients with distal finger complete dissection at the plane of nail root were treated by blocking one side of the proximal middle segment digital artery combined with wet dressing of heparin sodium cotton on the nail bed,which established the venous drainage and promoted the survival of the replanted finger.After anastomosing the bilateral digital artery, non-dominant side of the proximal middle segment digital artery was ligated.According to the principle of vascular pressure difference,a part of the dominant side of the finger arterial blood provided nutrition for replanted finger through the arterial arch.Another part flowed to the non-dominant side and enters the venous system through the capillaries in the middle segment.The normal venous system was formed later.Results All the10replanted fingers survived.The follow-up period ranged from3to15months with an average of10months.The nail of replanted fingers grew well without deformity.Slightly atrophy of finger body occurred.The sensation recovered toS2toS3+.According to the criteria of functional evaluation of finger replantation issued by the Hand Surgery Society of the Chinese Medical Association,the results were graded as excellent in8cases,good in1case and fair in1case.All the patients were satisfied with the appearance and function of the replanted fingers.Conclusion It is a simple and effective method for improving the survival rate of the replanted finger by blocking one side of the proximal middle segment digital artery combined with wet dressing of heparin sodium cotton on the nail bed,especially for the patients with severe contusion of injured fingers.