Department of Orthopedic Surgery, University of Michigan, Ann Arbor, MI.
J Hand Surg Am. 2020 Jul;45(7):626-637.e5. doi: 10.1016/j.jhsa.2020.04.006. Epub 2020 May 30.
Over the course of the last 60 years, microsurgical techniques, instrumentation, operating microscopes, and suture materials have all been perfected. Microsurgery training became part of the standard curriculum in plastic, orthopedic, and hand surgery programs. Despite those advances, limb replantation and transplantation are still surgical emergencies owing to limits in composite tissue viability under ischemia. Amputated parts, particularly containing large volumes of muscle, have to be revascularized within 4 hours in order to prevent permanent tissue damage. Static cold storage is the current standard to prolong ischemia time with limited success. Our research for the last 7 years has focused on extending ischemia time prior to revascularization. Our long-term goal is to make replantation and transplantation procedures elective. The following essay is the summary of our efforts.
在过去的 60 年中，显微外科技术、器械、手术显微镜和缝线材料都得到了完善。显微外科培训成为整形、骨科和手外科项目标准课程的一部分。尽管取得了这些进展，但由于缺血下复合组织的存活能力有限，肢体再植和移植仍然是外科急症。为了防止永久性组织损伤，必须在 4 小时内使包含大量肌肉的截肢部位重新血管化。目前，静态低温保存是延长缺血时间的标准方法，但效果有限。在过去的 7 年中，我们的研究重点一直是在重新血管化之前延长缺血时间。我们的长期目标是使再植和移植手术成为选择性手术。以下是我们努力的总结。
