From the Hansjörg Wyss Department of Plastic Surgery, and the Department of Orthopaedic Surgery, Hospital for Joint Diseases, New York University Langone Health.
Plast Reconstr Surg. 2019 Mar;143(3):551e-557e. doi: 10.1097/PRS.0000000000005343.
Interpositional grafts can be used to reconstruct the digital artery during revascularization and replantation when primary repair is not possible. The purpose of this study was to determine the effect of using interpositional grafts on the rate of digit survival.
A retrospective review of all patients from 2007 to 2016 that required revascularization and/or replantation of one or more digits was performed.
One hundred twenty-seven patients were identified with 171 affected digits (118 digital revascularizations and 53 digital replantations). A graft was used to repair the digital artery in 50 percent of revascularizations (59 of 118) and in 49 percent of replantations (26 of 53). There was no difference in digit survival with use of an interpositional graft for arterial repair versus primary repair in revascularization (91.5 percent in both groups) or replantation (48.1 percent versus 46.2 percent; p = 0.88). Regression analysis demonstrated no association between the use of interpositional grafts and digit survival. Interpositional grafting was more likely to be used in crush (62.5 percent) and avulsion injuries (72.2 percent) compared with sharp laceration injuries (11.1 percent), with a relative risk of 5.6 (p = 0.01) and 6.5 (p = 0.006), respectively.
There was no difference in the survival rate of amputated digits that required interpositional grafting for arterial repair. The need for an interpositional graft in a large zone of injury should not be considered a contraindication to performing revascularization or replantation. Furthermore, hand surgeons should have a low threshold for using interpositional grafts, especially in crush or avulsion injuries.
CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, III.
在无法进行一期修复时，可使用 移植物 来重建血运重建和再植时的指动脉。本研究旨在确定使用移植物对指体存活率的影响。
对 2007 年至 2016 年期间所有需要重建和/或再植一个或多个指体的患者进行回顾性分析。
共确定 127 例患者，171 个受累指体（118 例血运重建，53 例再植）。50%的血运重建（59/118）和 49%的再植（26/53）采用移植物修复指动脉。在血运重建中，动脉修复使用移植物与一期修复的指体存活率无差异（两组均为 91.5%）；再植中，使用移植物与一期修复的指体存活率无差异（48.1%对 46.2%；p=0.88）。回归分析表明，移植物的使用与指体存活率之间无相关性。与锐器切割伤（11.1%）相比，挤压伤（62.5%）和撕脱伤（72.2%）更可能使用移植物，相对风险分别为 5.6（p=0.01）和 6.5（p=0.006）。
需要动脉修复移植物的指体存活率无差异。大范围损伤需要移植物不应作为行血运重建或再植的禁忌证。此外，手部外科医生应该降低使用移植物的门槛，尤其是在挤压伤或撕脱伤中。
临床问题/证据水平：治疗性，III 级。
