Huang Hui-Fu, Yeong Eng-Kean
Dou Liou City and Taipei, Taiwan From the Department of Surgery, Plastic Division, National Taiwan University Hospital.
Plast Reconstr Surg. 2015 Jan;135(1):174-178. doi: 10.1097/PRS.0000000000000796.
Although digit amputation at or distal to the distal interphalangeal joint is a common injury, it remains a challenging problem to restore digital length and pulp because of the lack of healthy vessels and the absence of proper vascular size for reanastomosis. The purpose of the present study was to review the authors' clinical experience with distal digital replantation and to test the hypothesis that success in distal digit replantation is not dependent on venous anastomosis.
Twenty-eight patients with 31 complete distal digit amputations were included in the study. Data regarding patient demographic, replantation technique, and surgical outcome were analyzed.
Sixteen digits were replanted with arterial and venous anastomoses (group A). Eleven digits were replanted with only arterial anastomosis (group B). Composite grafting was performed in four digits without vascular anastomosis (group C). The success rates in group A and group B were 81.3 and 81.8 percent, respectively. None of the composite grafts survived. Fisher's exact test was used for statistical analysis. Although group C has the lowest survival rate (p < 0.05), the differences between the survival rates in group A and group B (p > 0.05) were insignificant.
The overall success rate of distal digit replantations in the authors' series was 81 percent, and there were no differences in the survival rates between replantations with and without venous anastomosis. Finally, the authors conclude that success in distal digit replantation is not dependent on venous anastomosis and suggest that replantation should be encouraged in complete distal digital amputation, even without venous anastomosis.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
尽管远节指间关节及以远的手指离断是一种常见损伤，但由于缺乏健康血管且没有合适的血管口径进行再吻合，恢复手指长度和指腹仍是一个具有挑战性的问题。本研究的目的是回顾作者在远节手指再植方面的临床经验，并验证远节手指再植成功不依赖静脉吻合这一假说。
本研究纳入了28例患者的31例完全性远节手指离断。分析了患者人口统计学、再植技术及手术结果等数据。
16例手指进行了动静脉吻合再植（A组）。11例手指仅进行了动脉吻合再植（B组）。4例手指未进行血管吻合，采用了复合组织移植（C组）。A组和B组的成功率分别为81.3%和81.8%。所有复合组织移植均未存活。采用Fisher精确检验进行统计学分析。尽管C组存活率最低（p<0.05），但A组和B组存活率之间的差异无统计学意义（p>0.05）。
作者系列中远节手指再植的总体成功率为81%，有无静脉吻合的再植存活率无差异。最后，作者得出结论，远节手指再植成功不依赖静脉吻合，并建议对于完全性远节手指离断，即使没有静脉吻合，也应鼓励进行再植。
临床问题/证据级别：治疗性，III级。
