Nazerani Shahram, Motamedi Mohammad Hosein Kalantar, Ebadi Mohamad Reza, Nazerani Tara, Bidarmaghz Bardia
Department of Surgery, Iran University of Medical Sciences, Tehran, Iran.
Tech Hand Up Extrem Surg. 2011 Sep;15(3):144-50. doi: 10.1097/BTH.0b013e31820504c9.
More than 40 years has passed since the first successfu0l replantation and thousands of fingers have been salvaged. We present our experience with distal finger replantation during 20 years of surgery. From 1990 to 2010, 420 replantations were performed; 64 of 420 cases were distal finger replantations. We discuss the indications, techniques, and outcomes of these difficult cases.
The records of 64 patients were reviewed and the demographics, methods of replantation, success rates, and complications were evaluated. Bone shortening was performed and fixation method in this zone was mostly pin fixation. The "Bench Technique" for the amputated part consisted of preparing the artery, vein, and nerve. In zones 1 and 2a, the veins are volar and when incising the skin for dissection, utmost care was taken to save the volar delicate veins and prepare them for outflow. When there was no vein found, dissection was toward finding 2 arteries, 1 for inflow and 1 for outflow. Medicinal leeches were used during the first 10 years. Chemical leeching was used thereafter.
Our patients were mostly young male workers and from the industrial sector. Our success rate of 87% was similar to the current literature. The overall complication rate from minor wound infection was 35% and total finger loss was 13%. Medicinal leeches had minimal satisfactory results. Chemical leeching was more effective.
Our 20-year experience with distal finger replantation showed a success rate of 87%. On account of cultural beliefs amputation is not tolerated well in Eastern cultures. Thus, a high rate of single finger replantations is seen. The success rate is similar to that of the literature and cosmetic results are far superior to replantation in other zones.
自首次成功再植手术过去40多年以来，已有数千根手指得以挽救。我们介绍20年手术期间进行末节手指再植的经验。1990年至2010年，共进行了420例再植手术；其中64例为末节手指再植。我们讨论这些疑难病例的适应证、技术及结果。
回顾64例患者的记录，评估其人口统计学资料、再植方法、成功率及并发症。进行了骨缩短，该区域的固定方法主要是克氏针固定。离断指体的“操作台上技术”包括准备动脉、静脉和神经。在1区和2a区，静脉位于掌侧，切开皮肤进行解剖时，要极其小心地保留掌侧的细小静脉并准备用于流出。若未发现静脉，则向寻找2条动脉的方向解剖，1条用于流入，1条用于流出。最初10年使用药用水蛭，此后使用化学水蛭疗法。
我们的患者大多是年轻男性工人，来自工业领域。我们87%的成功率与当前文献报道相似。轻微伤口感染的总体并发症发生率为35%，手指完全丧失率为13%。药用水蛭效果欠佳。化学水蛭疗法更有效。
我们20年的末节手指再植经验显示成功率为87%。由于文化观念，在东方文化中截肢不太容易被接受。因此，单指再植率较高。成功率与文献报道相似，美容效果远优于其他区域的再植。
