Chiu H Y
Department of Surgery, National Cheng-Kung University Hospital, Tainan, Taiwan, R.O.C.
J Formos Med Assoc. 1992 Sep;91 Suppl 3:S214-21.
With the development of microsurgery, replantation surgery have become the method of choice in treating the digit amputations. Although better than 90% of successful rate can be achieved in replanting guillotine type amputation, the final functional recovery is the main goal. The indications include: (1) thumb amputations, (2) Zone I amputation, (3) multiple digits, (4) bilateral amputation, (5) hemi-hand amputations, (6) hand amputation at wrist to upper forearm, and (7) pediatric amputations. And the contraindications include: (1) life-threatening associated injuries, (2) technically impossible, and (3) self-inflicted injuries. As for condition which have been previously put in the contraindication categories, such as: (1) single finger amputation, (2) Zone II amputations, (3) severe crush or avulsion injuries, (4) geriatric amputations, and (5) lengthy ischemia time amputations, the decision of to replant or not to replant was not a straight forward one. The decisions are individualized to meet the needs of different patients.
随着显微外科的发展，再植手术已成为治疗断指的首选方法。尽管在切割伤断指再植中成功率可达90%以上，但最终的功能恢复才是主要目标。其适应证包括：（1）拇指离断；（2）Ⅰ区离断；（3）多指离断；（4）双侧离断；（5）半侧手离断；（6）腕部至上臂中段的手部离断；（7）小儿断指。其禁忌证包括：（1）危及生命的合并伤；（2）技术上无法实施；（3）自残伤。至于以前被列为禁忌证的情况，如：（1）单指离断；（2）Ⅱ区离断；（3）严重挤压或撕脱伤；（4）老年断指；（5）缺血时间较长的断指，是否进行再植并非简单的决定。决策应个体化，以满足不同患者的需求。
