手部毁损伤急诊回植修复与重建

Emergency repair and reconstruction of smashed wounds in hands

目的报告手部严重毁损性离断急诊回植修复与重建的方法和疗效。方法自2008年5月至2017年2月，我们对45例手部严重复杂创伤患者，急诊采用不同的回植方法进行修复重建手功能。结果术后42例回植指全部存活，2例局部边缘坏死，经换药创面愈合。1例再植3指，存活1指，坏死2指，行坏死指体清除，残端缝合术。经1至3年随访，42例全部存活的再植指皮肤色泽红润，感觉、捏、持、提、拉等功能和外形恢复满意，生活能够自理。按中华医学会手外科学会上肢部分功能评定试用标准评定：优4例、良25例、可12例、差1例，优良率为69．0％。结论利用有限的残余指体进行回植修复，重建功能，是治疗手部毁损性离断伤较为理想的方法。

Objective To report the method and clinical effects of emergency repair and reconstruction of smashed wounds in hands. Methods Form May 2008 to February 2017, 45 patients with severe hand trauma were treated by different replantation methods in our emergency department to repair and reconstruct hand function. Results After operation, 42 cases of replanted finger survived uneventfully. Local marginal necrosis occurred in 2 cases and completely healed after dressing change. One case had replantation of 3 fingers with 1 finger of survival and 2 fingers of necrosis. And removal of necrotic finger and suture of residual end were performed. After 1 to 3 years follow-up, the skin color of 42 cases of successfully replanted fingers was ruddy. The recovery of appearance, sensation and function of pinching, holding, lifting and pulling was satisfactory. The patients could take care of themselves. According to the upper extremity function evaluation criteria issued by the Hand Surgery Society of the Chinese Medical Association, the results were graded as excellent in 4 cases, good in 25 cases, fair in 12 cases and poor in 1 case with the excellent and good rate being 69.0%. Conclusion Application of limited residual finger for hand replantation and functional reconstruction in an ideal method for the treatment of smashed wounds in hands.