改良去表皮腹部包埋法在甲弧影以远指尖离断中的应用

Treatment and application of improved deepithelialized abdomen embedding for slavage of the amputated fingertip distant from nail lunula

目的评估改良去表皮腹部包埋法对无法行血管吻合的甲弧影以远的指尖离断再植的疗效。方法选取2015年9月-2017年6月收治的15例18指甲弧影以远离断伤,所有的指尖离断均因血管缺损等原因,无法行血管吻合进行再植。采用去表皮后,原位缝合,腹部包埋。术后3周取出断指。结果 15例18指再植均成活,2例在取出时部分软组织坏死,经换药,瘢痕化愈合。1例女性患者因指体部分萎缩,对外形不满意,余患者均满意。DASH评分35~46分,平均38分。按照中华医学会上肢部分功能评定试用标准,优9例,良5例,可1例。半年后两点辨别觉为6~14 mm,平均8 mm。结论去表皮腹部包埋法对甲弧影以远的指尖离断再植有着较好的效果,可作为术中无法行血管吻合再植的替代手术。

Objective To explore the surgical approach and clinical efficacy of improved deepithelialized abdomen embedding for the amputated fingertip distant from nail lunula when vascular anastomosis is not feasible. Methods From September 2015 to June 2017, we treated 18 fingertip in 15 patients with deepithelialized abdomen embedding while all the fingertips was completely amputated and vascular anastomosis was not possible. After 3 weeks, all the fingertips were moved out by another surgery.Results Sixteen fingers survived completely, 2 fingers had partial necrosis, and achieved scar healing by dressing change. All patients were satisfied with the appearance of the fingertips while one women was not satisfied for ischemic atrophy. The DASH score was 35~46(average 38), the two-point discrimination was 6 ~14 mm(average 8 mm). Conclusion When vascular anastomosis is not feasible in fingertip replantation, improved deepithelialized abdomen embedding is a simple, feasible operation for the amputated fingertip distant from the nail lunula.