手指末节指甲半月线以远完全离断的再植

Replantation of complete amputation of fingertip distal to nail semilunar line

目的 报道手指末节指甲半月线以远 (yamanpl区Ⅱ型 )完全离断的再植方法及疗效。方法 在放大 10倍手术显微镜镜视下 ,对 11例 16指断指远、近端进行彻底的清创 ,扩大近端骨髓腔 ,用克氏针纵行固定末节指骨但不穿过关节。静脉回流利用髓腔静脉回流及甲缘放血法 ,动脉只吻合 1条指动脉弓终末支 ,结扎其余动脉分支。缝合 2条指神经终末支 ,去除甲板 ,在远断端甲床上作 3个纵行小切口 ,用肝素钠盐水棉片湿敷。结果 再植后 15指存活 ,1指坏死 ,再植存活率 93 .7%。术后随访 3～ 12个月 ,15指手指外形饱满 ,痛、温觉恢复 ,指腹二点分辨觉为 6～ 8mm。患指远侧指间关节屈伸活动正常。 13指患者指甲有纵嵴畸形。结论 末节yamanpl区Ⅱ型再植 ,采用吻合 1支终末支动脉 ,髓腔静脉回流及甲缘放血的方法可达到动 静脉血流平衡 ,提高了该型断指的存活率。

Objective To report the transplantation methods and treatment outcome of complete amputated fingertip distal to nail semilunar line ( Yamanpl district II type). Methods Under the 10 magnification of microsurgical loupe, thorough debridement was carried out for the proximal and distal part of amputated finger in 11 cases(16 lesions). After enlargement of the proximal marrow cavity, longitudinal fixation with k-wire was done in the distal phalange bone without crossing the distal interphalangeal joint. Vein reflowed by marrow cavity vein reflowing and nail edge bleeding. The end branch of digital artery arch was anastomosed, with ligation of all of the other artery branch. The 2 end branches of the digital nerve was also repaired. The nail plate was excised off. Three small longitudinal excision were done on the distal nail matrix. The cotton slice with heparin normal saline was applied. Results Fifteen fingers had uneventful results after transplantation and 1 case was necrotic, with survival rate 93.7%. The postoperative follow-up was 3～12 months. Fifteen fingers had satisfactory appearance with restoration of pain and temperature sensation and 6 ～ 8 mm in the 2-point discrimination. There was normal range of motion in the affected distal interphalangeal joint. Deformity at the longitudinal nail occurred in 13 fingers. Conclusion For the replantation of Yamanpl district II type at the fingertip, anastomosis of one end branch artery and marrow vein reflow and nail bleeding can obtain the artery-vein balance, enhancing the survival rate of this special amputated finger.