Stevanovic M V, Vucetic C, Bumbasirevic M, Vuckovic C
Hand and Microsurgery Department, University Orthopaedic Hospital and School of Medicine, Belgrade, Yugoslavia.
Plast Reconstr Surg. 1991 Jun;87(6):1099-104. doi: 10.1097/00006534-199106000-00012.
Avulsion amputations of the thumb are generally thought to have a worse prognosis after replantation than other amputations. We report the results of 17 thumbs that had an avulsion amputation and were replanted. Fourteen of the 17 survived (82 percent). Our experience indicated that the survival rate was improved by restoring continuity of at least two veins and two arteries, using a Y-shaped vein graft and the princeps pollicis artery for the source of arterial circulation. Nerve grafts were used to bridge defects in avulsed digital nerves. When possible, avulsed tendons were reattached to their muscle. Key pinch strength was 60 percent of normal, and grip strength was always less than that of the normal hand. The age of the patients and the cold ischemia time had no significant effect on either survival or function of the replanted thumb. When excellent venous backflow occurred immediately after the vessel repair and continued for at least 20 minutes, the thumb always survived without complications.
拇指撕脱性离断伤通常被认为再植后的预后比其他离断伤更差。我们报告了17例拇指撕脱性离断伤并进行再植的结果。17例中有14例存活（82%）。我们的经验表明，通过至少修复两条静脉和两条动脉的连续性，使用Y形静脉移植和以拇主要动脉作为动脉循环来源，可提高存活率。采用神经移植修复撕脱性指神经缺损。尽可能将撕脱的肌腱重新附着于其肌肉上。捏力为正常的60%，握力始终低于健侧手。患者年龄和冷缺血时间对再植拇指的存活或功能均无显著影响。当血管修复后立即出现良好的静脉回流并持续至少20分钟时，拇指总能存活且无并发症。
