手指洞穿性微型复合组织块离断再植16例

The replantation of penetrating severed finger with disconected micro tissue blocks in 16 cases

目的探讨手指洞穿性离断的微型复合组织块再植方法。方法2001年2月至2016年10月,对16例16指洞穿性离断手指的微型复合组织块仔细清创后进行再植。术中准确对位、精准修复,吻合指掌侧固有动脉主干或分支,无可供吻合动脉者采用皮下静脉动脉化等不同类型的血管搭配方式进行再植。术后随访组织块成活外观、感觉及关节功能情况。结果16例洞穿性离断微型复合组织块中,有1例部分表皮坏死,经换药愈合,其余再植手指洞穿性离断微型组织块全部成活。术后随访6个月~2年,再植的洞穿性微型复合组织块指体成活良好,颜色红润,感觉恢复S,-S4级,外观饱满,指纹清晰,关节屈、伸功能良好。结论手指洞穿性离断微型复合组织块应积极再植,通过熟练的显微外科技术进行精准的组织修复,不仅离断组织块可以再植成活,还保留了手指完整的外观、感觉和运动功能。

Objective To explore the method of replanting severed piercing finger micro tissue blocks.Methods From February,2001 to October,2016,16 cases of severed piercing finger micro tissue blocks were replanted with debridement.The trunk or branch of proper palmar digital artery was anastomosed.V ascular collocations were used such as venous arterialization when there was no anastomotic artery available.Regular postoperative followed-up was performed to observe the recovery of tissue survival,appearance,sensation of flap,and joint function.Results One case had partial epidermal necrosis,and healed after change of dressing.The finger-disconnected micro tissue blocks of other 15 cases survived well.After 6 months to 2 years of follow-up,the replanted micro tissue blocks were ruddy in color and recovered from S3 to Sa The appearance of the 16 fingers was good,and the function of joints was restored.Conclusion The finger--disconnected micro tissue blocks should be actively replanted.With skilled microsurgical techniques,the anastomosis of the arterial or venous artery will ensure the success of replantation and survived,as well as to restore good function and appearance.