Chen Shih-Yi, Wang Chih-Hsin, Fu Ju-Peng, Chang Shun-Cheng, Chen Shyi-Gen
Division of Plastic and Reconstructive Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
J Trauma. 2011 Jan;70(1):148-53. doi: 10.1097/TA.0b013e3181cc8553.
Composite grafting is used to treat nonreplantable fingertip amputations. This procedure has a high success rate and good results in treating fingertip amputations in children, but a lower success rate in adults.
From July 2007 to December 2008, 27 patients with 31 injured fingertips were admitted because of traumatic fingertip amputation at the emergency department of Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan. All 31 injured fingers had a nonreplantable distal amputated fingertip and underwent composite grafting. We refined the surgical technique by excising the bony segment, defatting, deepithelialization, tie-over suturing, and finger splinting to increase the graft survival. The patients' age, mechanism of damage, lesion size, surgical result, and postoperative complications were recorded.
The mean age of the patients was 40.5 years (range, 20-65 years). The average lesion size was 2.4 cm. Twenty-one fingers (67.7%) had been injured by crushing injury and the other 10 fingers (32.3%) by cutting injury. The overall graft survival rate was 93.5% (29 of 31). The average 2-point discrimination was 6.3 mm in the sixth month after the operation. The esthetic outcome evaluated by self-report questionnaire was 93.1% satisfied, and 86.2% of the patients could use their injured finger normally in daily work.
This easily performed and one-stage surgical procedure provided a reliable method for treating microsurgically nonreplantable fingertip amputations caused by hand trauma. The high overall success rate, satisfactory esthetic outcome, and good functional preservation helped patients return quickly to their daily life.
复合组织移植用于治疗无法再植的指尖离断伤。该手术在治疗儿童指尖离断伤方面成功率高且效果良好，但在成人中的成功率较低。
2007年7月至2008年12月，台湾台北国防医学中心三军总医院急诊科收治了27例因创伤性指尖离断伤导致31个手指受伤的患者。所有31个受伤手指均为无法再植的远端指尖离断伤，并接受了复合组织移植。我们通过切除骨段、去脂、去上皮、打包缝合和手指夹板固定等方法改进手术技术，以提高移植组织的存活率。记录患者的年龄、损伤机制、损伤大小、手术结果和术后并发症。
患者的平均年龄为40.5岁（范围20 - 65岁）。平均损伤大小为2.4厘米。21个手指（67.7%）因挤压伤受伤，另外10个手指（32.3%）因切割伤受伤。总体移植存活率为93.5%（31个手指中的29个）。术后第六个月平均两点辨别觉为6.3毫米。通过自我报告问卷评估的美学效果满意度为93.1%，86.2%的患者在日常工作中能够正常使用受伤手指。
这种操作简便的一期手术为治疗手部创伤导致的显微外科无法再植的指尖离断伤提供了一种可靠的方法。高总体成功率、满意的美学效果和良好的功能保留有助于患者快速恢复日常生活。
