Ozkan Omer, Ozgentaş H Ege, Safak Tunç, Dogan Ozlenen
Department of Plastic and Reconstructive Surgery, Akdeniz University Faculty of Medicine, Antalya, Turkey.
J Plast Reconstr Aesthet Surg. 2006;59(5):451-9. doi: 10.1016/j.bjps.2005.10.007. Epub 2006 Feb 2.
Although ring avulsion injuries are not common, when they do occur their management is still a challenging problem in reconstructive surgery. In this report, we present our microsurgical experiences with Kay's class III and IV ring avulsion injuries. A total of six patients with ring avulsion injuries were operated on between 2000 and 2004. Three patients were in class III with inadequacy of both arterial and venous circulation, and the remaining three were in class IV. The study consisted of four male and two female patients whose ages ranged from 23 to 43 (mean age 32). Average ischaemic time was 2.2 h (range 1-4 h). The ring finger was involved in all cases and microsurgical repair was performed using axillary block anaesthesia. The bone was detached at the level of the distal interphalangeal joint and soft tissues at the proximal phalanx level with the preserved proximal interphalangeal joint and flexor digitorum superficialis tendon in all cases. Because the zone of injury is more extensive, we debrided the avulsed digital artery over a long distance, and used long interpositional vein grafts radically in all patients. Venous drainage was accomplished by performing at least two vein anastomoses using vein grafts when necessary. Both digital nerves were repaired primarily after debridement. Results indicated that microsurgical repair had a success rate of 100%. The authors conclude that microsurgical reconstruction of ring avulsion injuries with intact proximal interphalangeal joint and flexor digitorum superficialis tendon yields superior results, both functionally and aesthetically, even in complete amputation.
尽管环形撕脱伤并不常见，但一旦发生，其治疗仍是重建外科中一个具有挑战性的问题。在本报告中，我们介绍了我们处理凯氏III级和IV级环形撕脱伤的显微外科经验。2000年至2004年间，共有6例环形撕脱伤患者接受了手术。3例为III级，动静脉循环均不足，其余3例为IV级。该研究包括4名男性和2名女性患者，年龄在23至43岁之间（平均年龄32岁）。平均缺血时间为2.2小时（范围1 - 4小时）。所有病例均累及无名指，采用腋路阻滞麻醉进行显微外科修复。所有病例中，均在远侧指间关节水平离断骨骼，在近节指骨水平离断软组织，保留近侧指间关节和指浅屈肌腱。由于损伤区域更为广泛，我们对撕脱的指动脉进行了长距离清创，并对所有患者均彻底使用了长段静脉移植。必要时，通过使用静脉移植至少进行两个静脉吻合来完成静脉引流。清创后，对两条指神经均进行了一期修复。结果表明，显微外科修复的成功率为100%。作者得出结论，即使在完全离断的情况下，对保留了近侧指间关节和指浅屈肌腱的环形撕脱伤进行显微外科重建，在功能和美观方面均能产生优异的效果。
