血管口径小于0.30 mm的小儿指尖再植体会

The clinical experience of fingertip replantation in children with blood vessel caliber less than 0.30 mm

目的探讨血管口径小于0.30mm的小儿指尖再植特点及临床疗效.方法自2020年1月至2022年5月,我科对12例12指血管口径小于0.30 mm的小儿指尖完全离断伤行再植手术,均成功吻合动脉.结果术后12例再植指体全部存活,其中1例术后7 d发生伤口感染,加强换药及应用敏感抗生素后再植指体存活.所有病例随访2~22个月,平均6个月,再植指体外形、功能恢复良好.按中华医学会手外科学分会断指再植功能评定试用标准评定:优9指,良3指.结论小儿指尖平面血管纤细,再植难度大,对术者的显微外科技术要求高.口径为0.10 mm的血管在显微镜视下难以辨别及吻合;口径为0.15 mm及以上的血管,只要方法得当,均可以吻合,具有再植条件,且术后效果满意.因此对于小儿的指尖完全离断伤,在离断指体内只要能找到口径0.15 mm及以上的动脉,临床上应尽量选择再植手术.

Objective To investigate the characteristics and clinical efficacy of fingertip replantation in children with vessel caliber less than 0.30 mm.Methods From January 2020 to May 2022,12 children with completely severed fingertips with vessel caliber less than 0.30 mm were treated with replantation of fingertips.All the replantation were successfully anastomosed and the replantation survived.Results All the 12 cases of replanted finger bodies survived,of which 1 case developed wound infection 7 days after operation.The replanted finger bodies survived after strengthening dressing changes and applying sensitive antibiotics.All the cases were follow-up for 2 to 22 months with an average of 6 months.The appearance and function of the replanted fingers recovered well.According to the evaluation criteria of replantation function of severed fingers issued by the Hand Surgery Society of the Chinese Medical Association,9 fingers were excellent and 3 fingers were good.Conclusion The blood vessels in the plane of fingertips in children are slender,and it is difficult to replant,requiring high microsurgical technique from the surgeon.It is difficult to identify and anastomose the vessels with the caliber of 0.10 mm under the microscope.For the vessels with the caliber of 0.15 mm or above,they can be anastomosed as long as the method is appropriate and the replantation conditions are satisfactory.Therefore,for completely amputated fingertips in children,replantation should be selected as long as the artery of caliber 0.15 mm or above can be found in the amputated finger.