Dodakundi Chaitanya, Jovanovic Nebojsa, Badawi Hamed, Alawadi Khalid
Department of Trauma and Orthopedics, Hand and Microsurgery Unit, Rashid Hospital, Dubai Health Authority, Dubai, United Arab Emirates.
Indian J Orthop. 2019 Sep-Oct;53(5):613-615. doi: 10.4103/ortho.IJOrtho_306_18.
The first reimplantation of a complete thumb amputation using microvascular anastomosis in a human was successfully conducted by Komatsu in 1968. Avulsion amputations of the thumb at the level of metacarpophalangeal joints pose a tedious task for direct arterial repair, even with adequate bone shortening. Owing to the short length of princeps pollicis from the deep arch, tight working space in the first web under microscope, and the associated intimal injuries, we advise transposing the radial indices artery in such cases which gives adequate length and noninjured artery for a tension-free repair. Using this method, surgeons can avoid the tedious task of vein grafts for arterial repair, reduce the operating time, and improve successful outcomes in thumb reimplantations.
1968年，小松首次成功地在人体上运用微血管吻合术对完全离断的拇指进行了再植。拇指在掌指关节水平的撕脱性离断，即使进行适当的骨缩短，直接进行动脉修复也是一项繁琐的任务。由于从深弓发出的拇主要动脉长度较短、显微镜下第一掌骨间隙的操作空间狭窄以及相关的内膜损伤，我们建议在这种情况下转位桡侧示指动脉，这样可以提供足够的长度且动脉未受损，便于进行无张力修复。使用这种方法，外科医生可以避免动脉修复时进行静脉移植的繁琐操作，减少手术时间，并提高拇指再植的成功率。
