Dagum Alexander B, Slesarenko Yury, Winston Lucy, Tottenham Virginia
Department of General Surgery, University Hospital, State University of New York, Stony Brook, NY 11794-8181, USA.
Tech Hand Up Extrem Surg. 2007 Dec;11(4):231-5. doi: 10.1097/bth.0b013e318070c716.
We report a successful replantation of a proximal-third avulsed left arm in a 26-year-old female with maintenance of good functional, clinical, Short Form 36, and the Disabilities of the Arm, Shoulder, and Hand outcomes results at 10 years. An organized approach combining staged surgical reconstruction and intense hand therapy allowed for both successful replantation and outcome. There exist no clear guidelines in making the decision between replantation and revision amputation. Controversy regarding the value of upper limb replantation seems to increase with ascending levels of amputation. A case report cannot provide guidelines, but several points can be made that may be of help to hand surgeons confronting this uncommon situation. In a highly motivated patient with realistic expectation, a preoperatively intact functioning shoulder should be considered an indication for attempt at replantation. With further staged reconstruction, a helper arm can still be achieved even in an avulsion-type amputation. Current operative and perioperative aspects of microsurgical replantation and subsequent reconstruction are discussed.
我们报告了一例26岁女性近端三分之一离断的左臂成功再植病例，术后10年其功能、临床状况、36条目简明健康状况调查量表（Short Form 36）以及上肢、肩部和手部功能障碍评估结果均良好。一种将分期手术重建与强化手部治疗相结合的有序方法使得再植手术成功且预后良好。在决定进行再植还是翻修截肢方面，目前尚无明确的指导原则。关于上肢再植价值的争议似乎随着截肢平面的升高而增加。一个病例报告虽不能提供指导原则，但可以提出几点，可能有助于手外科医生应对这种罕见情况。对于一位积极性高且期望现实的患者，术前功能完好的肩部应被视为尝试再植的指征。通过进一步的分期重建，即使是撕脱性截肢，仍可实现辅助上肢功能。本文还讨论了显微再植及后续重建的当前手术及围手术期相关问题。
