Zhu Zhao-Wei, Zou Xiao-Yan, Huang Yong-Jun, Liu Jiang-Hui, Huang Xi-Jun, He Bo, Wang Zeng-Tao
Department of Plastic Surgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province; Department of Orthopedics and Microsurgery, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China.
Department of Neurology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong Province, China.
Neural Regen Res. 2017 Nov;12(11):1911-1917. doi: 10.4103/1673-5374.219053.
Sensory function is the most significant criterion when evaluating the prognosis of replanted fingers. Current clinical research has focused on surgical techniques and indications for finger replantation; however, few studies have focused on recovery of finger sensory function after replantation. This study retrospectively assessed data of eight patients who had undergone nine Zone I replantations of the fingertips in the First Affiliated Hospital of Sun Yat-sen University of China from July 2014 to January 2016. Variations in the extent of damage, with the residual vessels or nerves in some fingers being too short or even missing, prevented tension-free suture repair in some patients. Thus, repair of four of the nine fingertips included arteriovenous anastomosis, the remaining five undergoing arterial anastomosis during replantation of the amputated fingers. Three patients underwent nerve repair, whereas the remaining six cases did not. Fingertip replantations were successful in all eight patients. Compared with the patients without vascular anastomosis, no obvious atrophy was visible in the fingertips of patients who did undergo vascular anastomosis during replantation and their sensory function did recover. Fingertip replantation provides good sensory function and cosmetic outcomes when good artery and vein anastomoses have been created, even when digital nerves have not been repaired.
在评估再植手指的预后时,感觉功能是最重要的标准。目前的临床研究主要集中在手指再植的手术技术和适应证上;然而,很少有研究关注再植后手指感觉功能的恢复情况。本研究回顾性分析了2014年7月至2016年1月在中国中山大学附属第一医院接受9例Ⅰ区指尖再植手术的8例患者的数据。由于损伤程度不同,部分手指的残留血管或神经过短甚至缺失,导致部分患者无法进行无张力缝合修复。因此,9例指尖再植中有4例采用了动静脉吻合,其余5例在断指再植时进行了动脉吻合。3例患者进行了神经修复,其余6例未进行神经修复。所有8例患者的指尖再植均成功。与未进行血管吻合的患者相比,再植时进行了血管吻合的患者指尖未见明显萎缩,感觉功能也得到了恢复。即使未修复指神经,只要建立了良好的动静脉吻合,指尖再植就能提供良好的感觉功能和外观效果。