吻合原位血管治疗严重手部脱套伤的临床疗效及长期随访

In situ vessel anastomosis in treatment of severe degloving injury of hand: clinical efficacy and long-term follow-up

目的:探讨吻合原位血管治疗严重手部脱套伤的可行性,长期随访观察其临床疗效。方法:自2016年1月至2018年12月,天津医院手显微外科共收治11例严重手部脱套伤患者,年龄16~51岁,平均31.5岁,其中右手6例,左手5例,均伴有指骨或掌骨骨折,急诊行吻合原位血管的再植术。术后本组病例均随访15个月以上,门诊观察术后患手的外观、感觉恢复及手功能恢复情况。结果:11例手术均取得成功,其中脱套组织全部成活6例;部分手掌皮肤坏死合并拇指甲床坏死1例,后行植皮及腹部皮瓣转移术修复;拇指甲床坏死2例,后行局部皮瓣转移术修复;手背皮肤坏死1例,行游离股前外侧皮瓣(ALTF)修复;手掌皮肤坏死1例,后行游离植皮覆盖;示、中指坏死1例、小指坏死1例,均行截指术。术后随访15~36(平均22)个月,根据中华医学会手外科学会上肢部分功能评定试用标准评定:优6例,良3例,可2例。参照英国医学研究会(BMRC)的标准,感觉恢复至S 45例,S 35例,S 21例。结论:通过精细的显微外科技术直接吻合原位血管治疗严重手部脱套伤,可达到远期较满意的手部功能恢复。

Objective To explore the feasibility and clinical efficacy of in situ vessels anastomosis in treatment of severe degloving injury of hand,and long-term follow-up observation of the clinical efficacy.Methods From January 2016 to December 2018,11 patients of severe degloving avulsion injuries were treated in the Department of Hand and Microsurgery of Tianjin Hospital.Six patients had right hands injuried and 5 in left hands.The age of patients ranged from 16 to 51 years old,with an average age of 31.5 years old.All injuries accompanied with metacarpal or phalangeal fractures.In situ vascular anastomosis was applied to all patients in the replantation surgery.Long-time follow-ups and observation of postoperative appearance,sensory and hand function recovery were conducted through visits of outpatient clinic.Results All operations were successful.All degloving tissues survived after replantation in 6 patients.Partial palm skin necrosis and thumb nail bed necrosis occurred in 1 patient,and treated with skin grafting and abdominal flap transfer.Thumb nail bed necrosis occurred in 2 patient,in which 1 patient repaired by abdominal pedicled flap transfer,and the other patient repair by local flap transfer.One patient had dorsal hand skin necrosis,and repaired with free anterolateral thigh flap(ALTF).One patient had palm hand skin necrosis,and repaired with free skin grafting.There were 1 patient had index and middle finger necrosis and 1 with little finger necrosis.And finger amputation was performed later.Mean follow-up period was 22(15-36)months.According to the Evaluation Standard of Upper Limb Partial Functional of Hand Surgery of Chinese Medical Association,6 patients were in excellent,3 in good and 2 in fair.According to the standard of British Medical Research Council(BMRC),sensation recovered to S4 in 5 patients,S3 in 5 patients and S2 in 1 patient.Conclusion Using precise microsurgical techniques to directly anastomose in situ vessels in the treatment of severe hand degloving injuries can achieve satisfactory long-term recovery of hand function.