Lin Tsan-Shiun, Yang Johnson Chia-Shen
From the Department of Plastic and Reconstructive Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Ann Plast Surg. 2014 Dec;73(6):662-7. doi: 10.1097/SAP.0b013e31828986b1.
Venous insufficiency after microsurgical replantation/revascularization remained to be a vexing problem for finger failure, despite the level of amputation. Other than redo the venous anastomosis, alternative methods such as subdermal pocket procedure (SDP) can be used. The aim of this study was to incorporate SDP immediately at the time of replantation, when no suitable vein is available after digital artery anastomosis; or, as a secondary salvage procedure to restore venous drainage for venous insufficiency after initial digital replantation/revascularization.
From 1999 to 2010, a total of 21 injured digits from 20 patients were collected. The mechanisms of injury included 6 guillotine amputations, 1 guillotine near-complete amputation, 12 crushing amputations, 1 crushing injury, and 1 crushing injury with contact thermal burn. The average patients' age was 34.5 years. Subdermal pocket procedures were used to all injured digits at different time frame as indicated. The patients were divided into 2 groups based on the timing of SDP, either primary or secondary. The pocketing period and the time lapse between the initial operation and the secondary salvaged SDP were also documented.
Group 1 (13 digits) received primary SDP as means of venous drainage immediately after digital artery revascularization. The mean pocketing period was 9.2 days, ranging from 7 to 15 days, with a 100% complete survival rate. Group 2 (8 digits) received secondary SDP as a salvage procedure when venous congestion became apparent later. The mean time lapse between initial operation and salvaged SDP was 53.1 hours. The average pocketing period was 7.5 days, with a 75% survival rate.
Secondary SDP provides an alternative salvage solution for postreplantation venous insufficiency without the need for further microsurgery.
尽管断指部位不同，但显微外科再植/血管重建术后的静脉功能不全仍然是导致手指再植失败的一个棘手问题。除了重新进行静脉吻合外，还可以采用其他方法，如皮下袋状手术（SDP）。本研究的目的是在再植时，当指动脉吻合后没有合适的静脉可用时，立即采用SDP；或者，作为一种二期挽救手术，用于在初次手指再植/血管重建术后恢复因静脉功能不全而导致的静脉引流。
1999年至2010年，共收集了20例患者的21根受伤手指。损伤机制包括6例切割伤、1例切割近完全离断伤、12例挤压离断伤、1例挤压伤和1例伴有接触性热烧伤的挤压伤。患者的平均年龄为34.5岁。根据不同的时间框架，对所有受伤手指均采用了皮下袋状手术。根据SDP的时机，将患者分为两组，即一期和二期。还记录了造袋期以及初次手术与二期挽救性SDP之间的时间间隔。
第1组（13根手指）在指动脉血管重建后立即接受一期SDP作为静脉引流方法。平均造袋期为9.2天，范围为7至15天，完全成活率为100%。第2组（8根手指）在后期出现静脉淤血时接受二期SDP作为挽救手术。初次手术与挽救性SDP之间的平均时间间隔为53.1小时。平均造袋期为7.5天，成活率为75%。
二期SDP为再植术后静脉功能不全提供了一种无需进一步显微手术的挽救方案。
