Akyürek M, Safak T, Keçik A
Department of Plastic and Reconstructive Surgery, Hacettepe University, Medical School, Ankara, Turkey.
Ann Plast Surg. 2001 Jun;46(6):605-12. doi: 10.1097/00000637-200106000-00006.
The authors describe the functional and aesthetic results of microsurgical replantation of 21 fingertip amputations at or distal to the nail base-namely, zone I amputations. There were 15 male and 6 female patients, with an average age of 26 years (age range, 1-41 years). Replantations were performed using the anastomosis of the artery-only technique, with neither vein nor nerve repair. Venous drainage was provided by an external bleeding method with a fish-mouth incision in "distal" zone I amputations for approximately 7 days, and by the use of leeches in more "proximal" zone I amputations for 10 to 12 days. Results indicated that the overall survival rate was 76%, with 16 of 21 digits surviving. Sensory evaluation at an average follow-up of 12 months (range, 6-18 months) revealed an average static two-point discrimination of 6.1 mm (range, 2.0-8.0 mm). Considering the unfavorable results and the donor site morbidity of various fingertip reconstructions, a microsurgical fingertip replantation should always be considered except in extremely distal, clean-cut, pediatric cases, in which case a composite graft is a possibility. The results of this series indicate that an amputated fingertip in zone I can be salvaged successfully by microvascular anastomosis of the artery only, with a nonmicrosurgical method of venous drainage. Furthermore, acceptable sensory recovery can be expected without any nerve coaptation.
作者描述了21例甲床及其远端指尖离断（即I区离断）的显微外科再植的功能和美学效果。患者有15名男性和6名女性，平均年龄26岁（年龄范围1 - 41岁）。采用仅吻合动脉技术进行再植，未进行静脉和神经修复。在“远端”I区离断中，通过鱼口状切口的外出血方法提供静脉引流约7天，在更“近端”的I区离断中使用水蛭提供静脉引流10至12天。结果表明，总体成活率为76%，21个手指中有16个存活。平均随访12个月（范围6 - 18个月）时的感觉评估显示，平均静态两点辨别觉为6.1毫米（范围2.0 - 8.0毫米）。考虑到各种指尖重建的不良结果和供区并发症，除了极远端、整齐切割的儿科病例（此类病例可能可行复合组织移植）外，应始终考虑显微外科指尖再植。本系列结果表明，I区离断的指尖仅通过动脉微血管吻合并采用非显微外科静脉引流方法即可成功挽救。此外，无需任何神经吻合即可预期获得可接受的感觉恢复。
