Ozçelik Ismail Bülent, Purisa Hüsrev, Sezer Ilker, Mersa Berkan, Aydin Atakan
IST-EL Istanbul Hand Surgery, Microsurgery, and Rehabilitation Group, (IST-EL El Cerrahisi, Mikrocerrahi ve Rehabilitasyon Grubu), Istanbul, Turkey.
Acta Orthop Traumatol Turc. 2006;40(1):62-6.
We retrospectively evaluated replantations performed for distal amputations.
The study included 82 patients (75 males, 7 females; mean age 29 years; range 10 to 52 years) who underwent replantations distal to the distal interphalangeal joint for a total of 98 amputations. According to the Tamai classification, there were 58 zone 1 and 40 zone 2 amputations. Local digital anesthesia was used in 77 patients (93.9%). Arterial anastomosis was accomplished after bone fixation, and venous anastomosis and nerve repair were performed whenever possible. When venous anastomosis was not possible or in case of venous insufficiency, venous decompression was performed with heparinized gauze placed on the bleeding nail matrix. Functional results and the degree of patients' satisfaction with the cosmetic outcome were evaluated. The mean follow-up was 16 months (range 3 to 46 months).
Replantation was successful in 60 amputations (61.2%) and unsuccessful in 38 cases (38.8%). In successful cases, cosmetic results were satisfactory due to the preservation of the nail and finger length. Functional results were satisfactory in cases in which the distal interphalangeal joint could be preserved. Replantations for zone 1 amputations (74.1%) yielded better results than those performed for zone 2 amputations (42.5%).
Despite technical difficulties, replantations for distal finger amputations can provide satisfactory functional and cosmetic results.
我们回顾性评估了针对手指远节离断进行的再植手术。
本研究纳入了82例患者（75例男性，7例女性；平均年龄29岁；范围为10至52岁），他们因手指远节指间关节以远的离断伤共接受了98例再植手术。根据玉井分类法，其中有58例为1区离断伤，40例为2区离断伤。77例患者（93.9%）采用了局部指神经阻滞麻醉。在固定骨骼后进行动脉吻合，并且尽可能地进行静脉吻合和神经修复。当无法进行静脉吻合或存在静脉回流障碍时，在出血的甲床处放置肝素化纱布进行静脉减压。评估了功能结果以及患者对外观效果的满意程度。平均随访时间为16个月（范围为3至46个月）。
60例再植手术成功（61.2%），38例失败（38.8%）。在成功的病例中，由于保留了指甲和手指长度，外观效果令人满意。在能够保留远节指间关节的病例中，功能结果令人满意。1区离断伤的再植手术（74.1%）比2区离断伤的再植手术（42.5%）效果更好。
尽管存在技术困难，但手指远节离断伤的再植手术仍可提供令人满意的功能和外观效果。
