Department of Plastic Surgery and Reconstructive Microsurgery, Clinic Hospital of Recovery, University of Medicine ``Iuliu Hatieganu'', Cluj Napoca, Romania.
UOD Reconstructive Microsurgery, AOU Città della Salute e della Scienza di Torino, Torino, Italy.
Injury. 2019 Dec;50 Suppl 5:S88-S94. doi: 10.1016/j.injury.2019.10.056. Epub 2019 Oct 21.
The aim of this paper was to evaluate the outcomes of a homogenous series of emergency with a toe-to-hand transfer reconstructions with a different timing: immediate (same surgical step with the debridement), primary (in the first 24 h), early (24-72 h after the debridement) or delayed (72 h-7 days).
Between 2001 and 2011, 31 patients received an immediate reconstruction with a toe-to-hand transfer. Data on indications, timing, type of surgery, complications and outcomes (sensory and motor recovery, patient satisfaction) were extrapolated and recorded.
Most of the procedures in our series (71%) were performed in the first 24 h. Survival rate was 100%. The only complications were 3 venous thrombosis (10%), solved with surgical re-exploration. Only 1 patient required secondary surgery for web deepening. No functional problems were recorded at the donor site. Sensibility recovery was acceptable in all patients; toe mobility was higher for the reconstructed thumb (85%) than for other digits (77%). Patient satisfaction was high with regard to functional results and lower but acceptable with regard to the aesthetic outcome. There was no difference in satisfaction rate of patients treated within 24 h or within 7 days.
No conclusive evidence exists in favor of an immediate versus a primary, early or delayed emergency reconstruction. Emergency toe transfer for finger reconstruction is a safe procedure and its outcomes are comparable to those reported in the literature for secondary reconstruction. Immediate reconstruction has the advantage of an easier dissection, but early or delayed reconstruction gives more time to discuss with the patient and to plan surgery.
本文旨在评估一系列急诊中使用同种方法进行的趾-手转移重建的结果，这些重建的时机不同：即刻（与清创术同时进行）、一期（在清创后 24 小时内）、早期（清创后 24-72 小时）或延迟（72 小时至 7 天）。
2001 年至 2011 年间，31 例患者接受了趾-手转移的即刻重建。我们提取并记录了适应证、时机、手术类型、并发症和结果（感觉和运动恢复、患者满意度）的数据。
我们系列中大多数手术（71%）在最初 24 小时内进行。存活率为 100%。唯一的并发症是 3 例静脉血栓形成（10%），通过再次手术探查解决。仅 1 例患者需要进行二期手术加深蹼状瘢痕。供区无功能问题。所有患者的感觉恢复均可接受；重建拇指的脚趾活动性（85%）高于其他手指（77%）。患者对功能结果的满意度较高，对美学结果的满意度较低但可接受。在 24 小时内或 7 天内接受治疗的患者的满意度没有差异。
目前尚无确凿证据表明即刻重建优于一期、早期或延迟急诊重建。对于手指重建，急诊趾转移是一种安全的手术，其结果与文献中报道的二期重建结果相当。即刻重建具有更容易解剖的优势，但早期或延迟重建可以有更多的时间与患者讨论并计划手术。
