Güntürk Özgün Barış, Kayalar Murat, Bali Ulaş, Özaksar Kemal, Toros Tulgar, Gürbüz Yusuf
Clinic of Orthopaedics, Traumatology and Hand Surgery, Emot Hospital, İzmir, Turkey.
Department of Plastic and Reconstructive Surgery, Manisa Celal Bayar University, School of Medicine, Manisa, Turkey.
Acta Orthop Traumatol Turc. 2020 Nov;54(6):577-582. doi: 10.5152/j.aott.2020.19016.
The aim of this study was to analyze the outcomes of revision surgery following replantation of single digital amputations.
In this study, first, a total of 403 patients (339 male, 64 female; mean age=28 years; age range=1-76) in whom a single finger replantation was performed were retrospectively reviewed, and then 60 patients with arterial or venous insufficiency in whom revision surgery was performed were reanalyzed. The second finger was observed to be the most injured one (32.8%). Injury type was classified as clean cut (25.3%), local crush (38.7), extensive crush (7.9%), and avulsion (28.1%). When taking the levels of injuries of the artery-only finger replantations into account, one finger (0.8%) was nail distal third, 70 fingers (56%) were nail distal third to lunula, 43 fingers (34.4%) were lunula to distal phalanx basis, 10 fingers (8%) were distal interphalangeal (DIP) joint, and one finger (0.8%) was middle phalanx. Operative revision was performed on 60 (14.9%) fingers. The need for operative revision was arterial insufficiency in 37 fingers (61.7%) and venous insufficiency in 23 fingers (38.3%). The average revision time was 43 (range=6-144) hours. While the average elapsed time for artery procedures was 35.3 (range=8-110) hours, the average elapsed time for vein procedures was 47.1 (range=6-144) hours. Finger survival rates were examined. Injury mechanism, amputation level, the number of artery/vein repairs and methods were examined in all patients and revision patients separately.
After the replantations, according to survival analysis, while 342 (84.9%) fingers were operated upon successfully, 61 (15.1%) fingers developed necrosis. In the patients with revision surgery, the survival rate was 78.3%. The need for revision was arterial insufficiency in 37 fingers (61.7%) and venous insufficiency in 23 fingers (38.3%). The revision rate was significantly lower than other injury types in clean-cut cases. In terms of levels of injury, no revisions were required from distal to lunula level, and the highest revision rate was observed at the proximal interphalangeal (PIP) joint level.
The results of the present study have shown that early re-exploration can provide a 78.3% success rate and can increase the survival rate from 67.6% to 84.2% following replantation of single digital amputations. Surgical re-exploration seems to be a reasonable salvage for replanted fingers with vascular insufficiency.
Level IV, Therapeutic study.
本研究旨在分析单指离断再植术后翻修手术的效果。
本研究首先对403例行单指再植的患者（男339例，女64例；平均年龄28岁；年龄范围1 - 76岁）进行回顾性分析，然后对60例行翻修手术的动脉或静脉功能不全患者进行再次分析。观察发现第二指损伤最为常见（32.8%）。损伤类型分为切割伤（25.3%）、局部挤压伤（38.7%）、广泛挤压伤（7.9%）和撕脱伤（28.1%）。仅考虑动脉损伤的手指再植水平时，1指（0.8%）为甲床远端三分之一处，70指（56%）为甲床远端三分之一至半月切迹，43指（34.4%）为半月切迹至远节指骨基部，10指（8%）为远侧指间关节（DIP），1指（0.8%）为中节指骨。对60指（14.9%）进行了手术翻修。手术翻修的原因是37指（61.7%）为动脉功能不全，23指（即38.3%）为静脉功能不全。平均翻修时间为43小时（范围6 - 144小时）。动脉手术的平均耗时为35.3小时（范围8 - 110小时），静脉手术的平均耗时为47.1小时（范围6 - 144小时）。检查了手指存活率。分别对所有患者和翻修患者的损伤机制、截肢水平、动静脉修复数量及方法进行了检查。
再植术后，根据生存分析，342指（84.9%）手术成功，61指（15.1%）发生坏死。在接受翻修手术的患者中，存活率为78.3%。翻修的原因是37指（6%.7%）为动脉功能不全，23指（38.3%）为静脉功能不全。在切割伤病例中，翻修率显著低于其他损伤类型。就损伤水平而言，从远节指骨至半月切迹水平无需翻修，近端指间关节（PIP）水平的翻修率最高。
本研究结果表明，早期再次探查可使成功率达到78.3%，并可使单指离断再植后的存活率从67.6%提高到84.2%。手术再次探查似乎是挽救血管功能不全再植手指的合理方法。
四级，治疗性研究。
