复杂手掌离断异位寄养再植一例并文献复习

The ectopic implantation and replantation of complicated hand secrance： One case report and literature review

目的 探讨复杂手掌离断异位寄养再植治疗中所遇到的困难及处理方法. 方法 2013年3月,收治1例复杂手掌旋转撕脱离断伤,精心设计手术方案,采用一期异位寄养再植,二期寄养手回植,三期伸肌腱移植修复重建,四期屈肌腱移植重建修复、指掌侧神经移植重建修复.在分析该病例资料的基础上,回顾相关文献. 结果 离断手掌寄养回植后完全成活,7个月后随访,回植3指指掌侧粗感觉部分恢复,手指活动度尚可. 结论 肢体离断异位寄养再植为挽救肢体提供了一种可行的方法,但此方法手术复杂,次数多,患者所承受的经济及精神负担较重,再植后肢体功能差,因此,应严格掌握适应证,评估患者所能承受的能力.

Objective To explore the difficulties may encounter and the managements adoptable during ectopic implantation ＆amp; replantation of the complicatedly severed hand.Methods In March,2013,management of a patient with complicatedly severed hand by rotary avulsion injury as well as the relative literature was systematically reviewed.After the Ⅰ-stage ectopic implantation,the Ⅱ-stage replantation,as well as the timely Ⅲ-stage and Ⅳ-stage extensor and flexor tendon transplantation and repair respectively.Results The severed hand survived evenly.A moderate sensation and mild motor function of the affected hand was acquired 7 months post-traumatically.Conclusion Managements including ectopic implantation ＆amp; replantation provide feasible methods for complicated limb severances,however,considering the operative complexity,the multi-stages required,the heavy economic and mental burden as well as the poor outcome,these operative indications should be strictly assessed.