Molski Marek
Klinika Chirurgii Plastycznej, Centrum Medyczne Kształcenia Podyplomowego w Warszawie.
Chir Narzadow Ruchu Ortop Pol. 2009 Sep-Oct;74(5):295-8.
Modification of replantation after total amputation of the fourth finger caused by ring avulsion injury was presented. It can be applied in finger amputations with bone or joint injury at the level or close to DIP joint. In proposed modification distal phalanx is removed from amputated part and remaining pulp tissues are transferred to middle phalanx. It enables primary vessel anastomoses after excision of their damaged ends. Moreover, it eliminates necessity of bone stabilization and tendon repair, shortens operation time, rehabilitation period and allows for earlier return to professional activity. This unique solution is particularly indicated in physical workers. Presented modification of finger replantation was successfully used in 44-year old female farmer. Despite 2 cm shortening of the fourth finger, vein grafts were used in restoration of blood outflow. Due to prolonged ischemia time significant edema of the dorsal aspect of the finger was present. Primary venous anastomoses were not possible due to resultant increased tension. All replanted tissues survived with good functional result. One year after the replantation and 2 months after the FDS tenolysis TAM was 180. Hand was aesthetically accepted by the patient.
介绍了因戒指撕脱伤导致第四指完全离断后再植的改良方法。它可应用于手指离断且在或接近远侧指间关节水平有骨或关节损伤的情况。在所提出的改良方法中，将远节指骨从离断部分移除，并将剩余的指腹组织转移至中节指骨。这样在切除受损血管末端后能够进行一期血管吻合。此外，它消除了骨固定和肌腱修复的必要性，缩短了手术时间和康复期，并允许更早恢复职业活动。这种独特的解决方案特别适用于体力劳动者。所介绍的手指再植改良方法成功应用于一名44岁的女性农民。尽管第四指缩短了2厘米，但使用静脉移植来恢复血液流出。由于缺血时间延长，手指背侧出现明显水肿。由于张力增加，无法进行一期静脉吻合。所有再植组织均存活，功能结果良好。再植一年后且在指浅屈肌腱松解术后两个月，掌指关节活动度为180度。患者对手的外观表示满意。
