Seattle, Wash. From the Division of Plastic Surgery, University of Washington.
Plast Reconstr Surg. 2014 Feb;133(2):333-342. doi: 10.1097/01.prs.0000437254.93574.a8.
Upper extremity replantation is a procedure that has revolutionized hand surgery. Since its introduction, a rapid evolution has occurred with a shifting focus from implant survival to optimization of functional outcomes and surgical efficiency. In this review, the current concepts surrounding the indications for replantation, variations in surgical technique, the factors affecting outcomes, and future directions of the specialty are analyzed.
A literature review was performed of all recent articles pertaining to digit, hand, and upper extremity replantation surgery. Particular emphasis was placed on comparative studies and recent meta-analyses.
The indications and contraindications for replantation surgery are largely unchanged, with mechanism of injury remaining one of the most important determinants of implant survival. With advances in surgical technique, improved outcomes have been observed with avulsion injuries. Distal tip replantations appear to be more common with improved microsurgical techniques, and for these distal injuries, digital nerve and vein repair may not be necessary. Cold ischemia time for a digit amputation should not preclude transfer to a replantation facility or significantly affect the decision to perform a replantation. However, transferring physicians should thoroughly review the options with patients to prevent unnecessary transfers, which is an area where telemedicine may be useful.
This review provides an update on the current concepts of the practice of replantation and the treatment and management of patients with upper extremity amputations.
断肢再植术是一项改变手外科面貌的手术。自开展以来，该技术迅速发展，重点从植入物的存活转移到优化功能结果和提高手术效率。在这篇综述中，分析了断肢再植的适应证、手术技术的变化、影响结果的因素以及该专业的未来方向。
对所有涉及断指、手和上肢再植手术的最新文章进行了文献回顾。特别强调了比较研究和最近的荟萃分析。
断肢再植手术的适应证和禁忌证基本不变，受伤机制仍然是决定植入物存活的最重要因素之一。随着手术技术的进步，撕脱伤的预后得到了改善。随着显微外科技术的提高，指尖再植更为常见，对于这些远端损伤，可能不需要修复指神经和静脉。指尖离断的缺血时间不应阻止将其转至再植机构，也不应显著影响进行再植的决策。然而，转诊医生应与患者充分讨论各种选择，以防止不必要的转诊，在这方面，远程医疗可能会有所帮助。
本综述提供了断肢再植术的最新概念，以及治疗和管理上肢截肢患者的更新内容。
