From the Division of Plastic Surgery, Department of Surgery, University of Washington; and Division of Plastic Surgery, Department of Surgery, University of Michigan.
Plast Reconstr Surg. 2022 Jul 1;150(1):105-116. doi: 10.1097/PRS.0000000000009185. Epub 2022 May 10.
Artery-only replantation may be necessary in circumstances when venous repair cannot be performed due to their size or vessel injury. Venous congestion of the replanted part is inevitable. A systematic review was performed to identify techniques for mitigating congestion and analyze the outcomes of those techniques.
A comprehensive literature search was performed to identify relevant articles related to artery-only replantation. An initial query identified 1286 unique articles. A total of 55 articles were included in the final review. Included studies were categorized by decongestive technique. Data from each article included the number of patients treated, level of amputation, graft use, anticoagulation or antiplatelet therapy, replant viability, and follow-up duration. Weighted averages were determined from studies that reported five or more digits.
A total of 1498 individual digital replantations were described. Very rarely did studies report artery-only replantation proximal to the distal interphalangeal joint. An overall survival rate of 78.5 percent was found irrespective of technique but was variable based on each particular study. Studies utilizing medicinal leech therapy were more likely to report use of intravenous anticoagulation, whereas surface bleeding techniques were more likely to report use of topical or local anticoagulant.
Lack of a vein for anastomosis should not be regarded as a contraindication to replantation. These digits instead require a method to establish reliable drainage sufficient to allow for low resistance inflow and maintain a physiologic pressure gradient across capillary beds. The surgeon should select a decongestive technique that best suits the patient and their specific injury.
在由于静脉尺寸或血管损伤而无法进行静脉修复的情况下，可能需要进行仅动脉再植。再植部分的静脉充血是不可避免的。进行了一项系统评价，以确定减轻充血的技术，并分析这些技术的结果。
进行了全面的文献检索，以确定与仅动脉再植相关的相关文章。最初的查询确定了 1286 篇独特的文章。共有 55 篇文章纳入最终综述。纳入的研究按去充血技术进行分类。从报告了 5 个或更多数字的每篇文章中获取患者数量、截肢水平、移植物使用、抗凝或抗血小板治疗、再植成活率和随访时间的数据。从报告了 5 个或更多数字的研究中确定加权平均值。
共描述了 1498 例单个手指再植。很少有研究报告在远节指间关节近端进行仅动脉再植。无论技术如何，总体存活率均为 78.5%，但根据每个特定研究的结果而有所不同。使用医用水蛭疗法的研究更有可能报告使用静脉内抗凝治疗，而表面出血技术更有可能报告使用局部或局部抗凝剂。
没有吻合的静脉不应被视为再植的禁忌症。这些手指需要一种方法来建立可靠的引流，以允许低阻力流入并维持毛细血管床上的生理压力梯度。外科医生应选择最适合患者及其特定损伤的去充血技术。
