摘要
目的探讨手掌组织块离断伤再植术中血液循环重建的治疗方法及临床疗效。方法自2014年1月至2021年10月,对6例含掌浅弓的手掌组织块离断伤患者进行再植术,术中吻合近断端掌浅弓两侧断端,吻合远断端指总动脉及示指桡侧指固有动脉、小指尺侧指固有动脉断端,吻合近断端掌浅弓两侧伴行静脉及近断端皮下静脉,重建手掌离断组织块及远端手指血液循环。术后1个月予压力套治疗,预防瘢痕增生及塑形手掌离断组织块外形。术后定期随访:再植组织块及远端指体皮肤质地、饱满、弹性、感觉、两点分辨觉、肿胀、皮温、瘢痕及功能。结果6例手掌离断组织块及远端手指均1期存活,再植成活率100%。术后随访6~24个月,平均15个月。再植存活组织块及远端指体质地好,外形饱满,弹性好,无明显肿胀,瘢痕无明显增生,皮温正常,感觉恢复S_(3)~S_(4),两点分辨觉4~12mm。根据中华医学会手外科学会断指再植功能评定试用标准评定患手功能:优4例,良2例。结论术中吻合近断端掌浅弓两侧断端,吻合远断端指总动脉及示指桡侧指固有动脉、小指尺侧指固有动脉断端,吻合近断端掌浅弓两侧伴行静脉及近断端皮下静脉,重建手掌离断组织块及远端手指血液循环,术后联合压力套塑形,可获得满意的再植成活率和临床疗效。
Objective To explore the treatment and clinical efficacy of reconstruction of blood circulation in the replantation of amputated injuries of palm tissues.Methods From January 2014 to October 2021,replantation was performed on 6 patients with amputated injuries of palm tissues containing the superficial palmar arch.During the operation,the amputated ends of the proximal superficial palmar arch were anastomosed.The distal amputated ends of the common digital artery,the radial proper digital artery of the index finger and the ulnar proper digital artery of the little finger were anastomosed.The accompanying veins on both sides of the superficial palmar arch at the proximal end and the subcutaneous veins at the proximal end were anastomosed to reconstruct the blood circulation of the amputated injuries of palm tissues and the distal finger.One month after the operation,pressure sleeve treatment was given to prevent scar hyperplasia and shape the appearance of the amputated injuries of palm tissues.The regular follow-up after operation included the texture,fullness,elasticity,sensation,two-point discrimination,swelling,skin temperature,scar and function of the replanted tissue mass and distal finger skin.Results Six cases of amputated injuries of palm tissuesand distal fingers achieved primary survival,and the survival rate of replantation was 100%.The patients were follow-up for 6 to 24 months,with an average of 15 months.The replanted living tissue mass and distal finger body have good texture,full appearance,good elasticity,no obvious swelling,no obvious scar hyperplasia,normal skin temperature,sensory recovery S_(3)to S_(4),and two-point discrimination being 4 to 12 mm.According to the trial standard of finger replantation function evaluation issued by the Hand Surgery Society of the Chinese Medical Association,the function of the affected hand was evaluated as excellent in 4 cases and good in 2 cases.ConclusionDuring the operation,the amputated ends of the proximal superficial palmar arch were anastomosed.The amp
作者
程贺云
巨积辉
张广亮
赵强
王本元
邹坤
刘爽
Cheng Heyun;Ju Jihui;Zhang Guangliang;Zhao Qiang;Wang Benyuan;Zou Kun;Liu Shuang(Department of Hand Surgery,Ruihua Hospital of Suzhou University,Suzhou 215104,China)
出处
《中华手外科杂志》
CSCD
北大核心
2022年第6期472-475,共4页
Chinese Journal of Hand Surgery
基金
苏州市姑苏卫生人才计划项目(2020075)
苏州市卫生科教临床重点病种诊疗技术专项(LCZX202026)
苏州市医疗卫生科技创新-应用基础研究(SKJY2021021)。
关键词
手损伤
显微外科手术
再植术
离断伤
Hand injuries
Microsurgery
Replantation
Amputated injuries
