Lin Chih-Hung, Aydyn Nihal, Lin Yu-Te, Hsu Chung-Tseng, Lin Cheng-Hung, Yeh Jiun-Ting
Division of Trauma, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan.
Ann Plast Surg. 2010 Mar;64(3):286-90. doi: 10.1097/SAP.0b013e3181b0bb37.
Ischemia tolerance has been a major concern during hand and finger replantation. Because of multiple referrals and damage control resuscitation, ischemia is occasionally prolonged for more than 24 hours. Amputation impairs functional efficiency in amputees; therefore, if there is a favorable indication for replantation, microsurgical replantation can be performed to salvage the function of the affected part to an acceptable extent.Between 1998 and 2006, 14 patients underwent 25 replantations after prolonged ischemia of more than 24 hours. Of the 14 patients, 12 were referred to our hospital after unsuccessful replantations and admitted to the emergency room. Two of these patients underwent thumb amputations, and 10 patients underwent multiple digit amputations. Two patients underwent wrist amputation with associated polytrauma and profound shock, both hand replantations were performed on the following day after ICU management with damage control resuscitation was performed to control excessive bleeding and stabilize vital signs.In this study, 16 replantations were successful and 9 failed; thus, the success rate was 64.0%. Several secondary procedures were required for restoring the functional ability of the reconstructed parts.Ischemia time is critical for limb salvage. Hands and fingers have very little muscle tissue. Hence, replantation of these parts can be performed even in the case of prolonged ischemia to restore the hand function.
缺血耐受一直是手部和手指再植过程中的主要关注点。由于多次转诊和损伤控制复苏，缺血时间偶尔会延长至24小时以上。截肢会损害截肢者的功能效率；因此，如果有再植的有利指征，可以进行显微外科再植，以在可接受的程度上挽救受影响部位的功能。1998年至2006年期间，14例患者在缺血超过24小时的长时间缺血后进行了25次再植手术。在这14例患者中，12例在再植失败后被转诊至我院并入住急诊室。其中2例患者进行了拇指截肢，10例患者进行了多指截肢。2例患者因多发伤和严重休克接受了腕部截肢，在ICU进行损伤控制复苏以控制出血过多并稳定生命体征后的第二天进行了双手再植。在本研究中，16例再植成功，9例失败；因此，成功率为64.0%。为恢复重建部位的功能能力需要进行几次二次手术。缺血时间对肢体挽救至关重要。手部和手指的肌肉组织很少。因此，即使在长时间缺血的情况下也可以进行这些部位的再植以恢复手部功能。
