血管吻合联合原位皮肤回植治疗手指皮肤逆行撕脱伤

Treatment of retrograde avulsion of finger skin with in situ skin replantation under vascular anastomosis

目的探讨吻合动静脉+撕脱皮肤回植治疗手指皮肤逆行撕脱伤的临床效果。方法回顾性分析2015年1月-2019年1月收治的手指皮肤逆行撕脱伤29例临床资料。其中采用吻合动静脉+撕脱皮肤回植(观察组)14例15指,采用原位皮肤回植+VSD负压吸引治疗(对照组)15例18指。对比两组术后回植皮肤成活例数、成活率及两点辨别觉,按中华医学会手外科学会断指再植评定试用标准对术后指体进行功能评价。结果观察组15指回植指体皮肤一期成活14指,回植成活率为93.3%;术后出现血管危象1指,手术探查后仍坏死,二期行植皮手术愈合。对照组18指回植指体皮肤一期成活13指,回植成活率为72.2%;术后出现坏死5指,小切口放血成活2指,余3指皮肤部分坏死,二期行植皮术后愈合。观察组两点辨别觉4~7 mm,平均(5.6±1.1)mm。根据中华医学会手外科学会断指再植评定试用标准评定:优10指,良3指,可2指,优良率86.7%。对照组两点辨别觉6~10 mm,平均(8.4±1.8)mm。根据中华医学会手外科学会断指再植评定试用标准评定:优8指,良4指,可6指,优良率66.7%。两组以上指标差异均有统计学意义。结论吻合动静脉+撕脱皮肤回植是治疗手指皮肤逆行撕脱伤的有效方式,值得临床推广应用。

Objective To investigate the clinical effect of arteriovenous anastomosis+avulsed skin replanting for the treatment of finger skin avulsed retrograde.Methods Twenty-nine cases of finger skin retrograde avulsion admitted to our hospital from January 2015 to January 2019 were reviewed.Among them,14 patients were treated with arteriovenous anastomosis+avulsed skin reimplantation(experimental group),and 15 patients were treated with in situ skin reimplantation+VSD negative pressure suction(control group).The number of skin survival cases,survival rate and two-point discrimination sensation were compared between two groups,and the postoperative finger function was evaluated according to the trial standard of finger replantation evaluation of Hand surgery Society of Chinese Medical Association.Results In the experimental group,14 fingers survived in the first stage,and the survival rate was 93.3%.Vascular crisis occurred in 1 finger after surgery,but necrosis still occurred after surgical exploration,and the second phase of skin grafting was successfully healed.In the control group,13 fingers survived in the first stage,and the survival rate was 72.2%.After surgery,5 fingers were necrotic,2 fingers survived by small incision bloodletting,and the remaining 3 fingers were partially necrotic,and the second stage healed after skin grafting.In the experimental group,the two-point discrimination was 4-7 mm,with an average of(5.6±1.1)mm.According to the trial evaluation standard of the Hand Surgery Society of The Chinese Medical Association:excellent in 10 digits,good in 3 digits,fair in 2 digits,the excellent and good rate was 86.7%.In the control group,the two-point discrimination was 6-10 mm,with an average of(8.4±1.8)mm.According to the trial evaluation standard of finger replantation evaluation of Hand Surgery Society of Chinese Medical Association:excellent in 8 digits,good in 4 digits,fair in 6 digits,the excellent and good rate was 66.7%,the difference of above indexes between two groups was statistically significant.Conclusion Arteriovenous anastomosis+avulsed skin replanting is an effective method for the treatment of finger retrograde avulsed skin injury,which is worthy of clinical application.