吻合甲侧襞静脉重建指尖再植回流

Reconstruction of reflux in fingertip replantation by anastomosis of nailfold vein

目的探讨吻合甲侧襞静脉在指尖再植回流重建中的临床效果。方法自2016年11月至2017年12月,我们对18例23指IshikawaⅡ区即甲中部至甲根平面的指尖离断患者进行再植,术中采用甲旁纵行辅助切口,探查并吻合甲侧襞静脉重建断指回流,并随访临床效果。结果术后随访时间为8~15个月,平均11.1个月,23指中21指存活,2指坏死,成活率为91.3%.所有存活指尖均恢复保护性感觉,两点分辨觉为(8.8±2.4)mm,远指间关节主动活动度为(49.8±12.3)°,为健侧的63.4%,平均指腹血流灌注量为健侧的89.3%。并发症包括环形瘢痕挛缩(5/23)、指甲畸形(7/23)、骨不连(1/23)、远指间关节功能障碍(4/23)、寒冷不耐受(423)。结论甲侧裝静脉可在指尖再植中提供可靠的静脉回流,恢复再植指体较好的外观及功能。

Objective To explore the clinical efficacy of anastomosis of nailfold vein in reconstruction of reflux of fingertip replantation.Methods From November 2016 to December 2017,18 patients with 23 fingers of fingertip amputation in Ishikawa U area(from middle nail to nail root plane)were replanted.The parathyroidal longitudinal incision was used to explore and anastomose the nailfold vein to reconstruct the severed finger reflux,and the clinical efficacy was followed up.Results The follow?up period ranged from 8 to 15 months,with an average of 11.1 months.Twenty-one of the 23 fingers survived and two were necrotic.The survival rate was 91.3%.The protective sensation was restored in all surviving fingertips.The two-point discrimination was(8.8±2.4)mm.The active range of motion of distal interphalangeal joint was(49.8±12.3)°,which was 63.4% of the healthy side.The average blood perfusion volume of finger pulp was 89.3% of the healthy side.The complications included cicatricial contracture(5/23),nail deformity(7/23),nonunion(1/23),distal interphalangeal joint dysfunction(4/23),and cold intolerance(4/23).Conclusion The nailfold vein can provide reliable venous reflux in fingertip replantation and restore the good appearance and function of replanted fingertips.