Wu Fei, Shen Xiaofang, Eberlin Kyle R, Sun Zhibo, Zhou Xiao, Xue Mingyu
Department of Orthopaedic Surgery, Renmin Hospital of Wuhan University, Wuhan, China.
Department of Hand Surgery, Wuxi N0.9 People's Hospital affiliated to Soochow University, Wuxi, China.
Injury. 2018 Jun;49(6):1113-1118. doi: 10.1016/j.injury.2018.03.027. Epub 2018 Mar 27.
The purpose of this study was to evaluate outcomes for patients sustaining a distal fingertip amputation who underwent replantation witharteriovenous anastomosis for venous drainage over a one year period at our institution. This technique has been utilized when insufficient veins are identified in the amputated part for standard veno-venous anastomosis.
A retrospective study was performed on patients presenting from 2013 to 2014. Guillotine, crush, and avulsion/degloving injuries were included if they underwent fingertip (Tamai Zone I) replantation with arterial anastomosis for vascular inflow and arteriovenous anastomosis for venous drainage. The cases were further classified as Ishikawa subzone I and subzone II.
Arteriovenous anastomosis for venous drainage during replantation was used in 45 digits in 35 patients. 41 of the 45 digits underwent successful replantation using this technique (91%). The mean active ROM in the DIP joint of the fingers and in the IP joint of thumbs was 65° and 57°, respectively. Sensory evaluation demonstrated a mean of 6.9 mm s2PD in digits where the digital nerves could be repaired. 11 replanted digits without nerve repair regained some sensory recovery with a mean of 9.6 mm s2PD. 91% of patients were highly satisfied with the appearance of the replanted digits based on Tamai criteria.
Arteriovenous anastomosis for venous outflow should be considered during zone I fingertip replantation if sufficient veins are not identified in the amputated part. This technique may allow for more routine and successful distal replantation.
本研究的目的是评估在我们机构接受动静脉吻合进行静脉引流的指尖离断再植患者在一年期间的治疗效果。当在离断部分未发现足够的静脉进行标准的静脉-静脉吻合时，会采用这种技术。
对2013年至2014年就诊的患者进行回顾性研究。如果患者接受了指尖（玉井I区）再植，采用动脉吻合进行血管流入，动静脉吻合进行静脉引流，则纳入铡刀伤、挤压伤和撕脱/脱套伤。这些病例进一步分为石川I亚区和II亚区。
35例患者的45个手指在再植过程中采用了动静脉吻合进行静脉引流。45个手指中的41个采用该技术成功再植（91%）。手指远侧指间关节和拇指指间关节的平均主动活动范围分别为65°和57°。感觉评估显示，在可修复指神经的手指中，平均两点辨别觉为6.9 mm。11个未进行神经修复的再植手指恢复了一些感觉，平均两点辨别觉为9.6 mm。根据玉井标准，91%的患者对再植手指的外观非常满意。
如果在离断部分未发现足够的静脉，在I区指尖再植过程中应考虑采用动静脉吻合进行静脉流出。这种技术可能使更常规和成功的远端再植成为可能。
