Kokkoli Effrosyni, Spyropoulou Georgia-Alexandra, Shih Hsiang-Shun, Feng Guan-Ming, Jeng Seng-Feng
Kaohsiung, Taiwan; and Thessaloniki, Greece From the Department of Plastic and Reconstructive Surgery, E-Da hospital, I-Shou University; and the Department of Plastic and Reconstructive Surgery, Aristoteles University of Thessaloniki, Papageorgiou General Hospital, Periferiaki Odos N. Efkarpia.
Plast Reconstr Surg. 2015 Nov;136(5):1015-1026. doi: 10.1097/PRS.0000000000001721.
In the complex and challenging treatment of a mutilating hand injury, any available resources need to be primarily recruited. Besides direct digital replantation, the tissue of the nonreplantable "spare parts" could often be "recycled," and also some replantable or injured structures could be "redistributed" in a more functional individualized pattern, irrespective of their initial origin.
Ten patients, six male and four female, were treated for multidigital mutilating injury with various "heterotopic" procedures. Immediate digital heterotopic replantations were performed in seven patients. In one case, the bone and skin of a nonreplantable digital part were used as grafts in the reconstruction of a metacarpal bone and the overlying skin defect. A neurovascular fillet flap from a nonreplantable finger for the reconstruction of the webspace and a pollicization of an injured index were undertaken in two further cases. Another patient underwent pedicled transfer of the proximal interphalangeal joint and metacarpal bone of an impaired index to the middle finger.
Sensate prehensile function was restored in 100 percent of the cases, and the ability for tripod pinch and more subtle tasks was restored in 90 percent. The minimum of two long fingers and a thumb was restored in every case, and the patients judged the appearance of their hands as "acceptable."
In the reconstruction of a mutilating hand injury, besides and beyond the straightforward microsurgery, the various heterotopic procedures are essential reconstructive tools that can enhance the versatility of the hand surgeon when pursuing a better outcome.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.
在复杂且具有挑战性的毁损性手部损伤治疗中，需要首先调动一切可用资源。除了直接进行断指再植外，不可再植的“备用部件”组织通常可以“回收利用”，而且一些可再植或受伤的结构也可以以更具功能性的个体化方式“重新分配”，而不论其最初的来源。
10例患者（6例男性，4例女性）接受了各种“异位”手术治疗多发性手指毁损伤。7例患者进行了即时手指异位再植。1例患者将不可再植手指部分的骨骼和皮肤用作移植材料，用于重建掌骨及覆盖其上的皮肤缺损。另外2例患者采用不可再植手指的神经血管蒂皮瓣重建指蹼间隙，并对受伤的示指进行拇指化手术。另1例患者将受损示指的近端指间关节和掌骨带蒂转移至中指。
所有病例均恢复了具有感觉的抓握功能，90%的病例恢复了三点捏和更精细动作的能力。每例患者至少恢复了两根长手指和1根拇指，患者对手部外观的评价为“可接受”。
在毁损性手部损伤的重建中，除了常规的显微外科手术外，各种异位手术是重要的重建工具，在追求更好治疗效果时可增强手外科医生的手术灵活性。
临床问题/证据水平：治疗性研究，IV级。
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