The Ninth People's Hospital Affiliated to Soochow University, 177544Soochow University, Wuxi, Jiangsu, China.
J Orthop Surg (Hong Kong). 2020 Sep-Dec;28(3):2309499020962861. doi: 10.1177/2309499020962861.
Venous anastomosis is the key procedure for Ishikawa zone Ⅱ fingertip replantation. Both palmar and lateral veins provide efficient venous drainage. This study compared the clinical effects between these venous anastomoses for fingertip replantation.
In 2016-2018, 61 patients underwent Ishikawa zone Ⅱ fingertip replantation with venous anastomosis (28 and 33 cases with palmar and lateral anastomoses, respectively). Retrospective comparative analyses evaluated surgical technique and function, including operative time; rates of finger survival, venous congestion, and infection; sensation; joint motion; cold intolerance symptom severity (CISS), Disabilities of the Arm, Shoulder, and Hand (DASH), and Vancouver scar scores; and chronic regional pain syndrome (CRPS) rates.
There were 33 patients with lateral vein anastomosis and 28 patients with palmar vein anastomosis. The average patient follow-up was 18.2 months. The survival rates did not differ significantly between groups (87.8% (29/33) vs. 85.7% (24/28), > 0.05); however, the operative time was shorter in the lateral vein group than in the palmar vein group (78.57 ± 7.08 min vs. 67.88 ± 5.77 min, < 0.05). Venous congestion and infection rates did not differ significantly between groups ( > 0.05). The replanted finger function, including joint motion, sensation, DASH scores, Vancouver scar scores, and CRPS rates, did not differ significantly between groups ( > 0.05). However, the CISS score was higher in the palmar vein group than in the lateral vein group (44.39 ± 5.16 vs. 38.09 ± 4.49, < 0.05).
Venous anastomosis with either palmar or lateral veins showed high survival rates and good function in fingertip replantation. The lateral vein had a shorter operative time and benefit to arterial revision and was especially suitable for patients with finger pulp damage.
静脉吻合是 Ishikawa Ⅱ区指尖再植的关键步骤。掌侧和侧静脉均提供有效的静脉引流。本研究比较了这两种静脉吻合在指尖再植中的临床效果。
2016 年至 2018 年，61 例患者行 Ishikawa Ⅱ区指尖再植，其中 28 例行掌侧吻合，33 例行侧吻合。回顾性对比分析评估手术技术和功能，包括手术时间；手指存活率、静脉淤血、感染率；感觉；关节活动度；怕冷症状严重程度（CISS）、上肢功能障碍（DASH）和温哥华瘢痕评分；以及慢性区域性疼痛综合征（CRPS）发生率。
侧静脉吻合 33 例，掌静脉吻合 28 例。平均随访 18.2 个月。两组存活率无显著差异（87.8%（29/33）与 85.7%（24/28），>0.05）；但侧静脉组手术时间短于掌静脉组（78.57±7.08min 与 67.88±5.77min，<0.05）。静脉淤血和感染率两组无显著差异（>0.05）。再植手指功能，包括关节活动度、感觉、DASH 评分、温哥华瘢痕评分和 CRPS 发生率，两组无显著差异（>0.05）。但掌静脉组 CISS 评分高于侧静脉组（44.39±5.16 与 38.09±4.49，<0.05）。
掌侧或侧静脉吻合在手指出血再植中均有较高的存活率和良好的功能。侧静脉手术时间短，有利于动脉修正，特别适用于指尖皮肤损伤的患者。
