Yeh Jui-Po, Lin Tsan-Shiun
From the Department of Plastic and Reconstructive Surgery, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
Ann Plast Surg. 2023 Apr 1;90(1 Suppl 1):S89-S94. doi: 10.1097/SAP.0000000000003351. Epub 2022 Dec 8.
Microsurgical replantation of fingertip amputation is sometimes difficult because of a lack of available vessels. Composite grafting is an alternative method for nonvascularized replantation, but it has a limited success rate. The subdermal pocket (SDP) procedure is proposed to increase the survival of composite graft.
We aimed to compare the success rate of the composite graft used in fingertip replantation with or without application of the SDP procedure.
From 2000 to 2020, 29 fingertip amputations (28 complete amputations, 1 near-complete amputation) from 28 patients were included. Five of the fingertip amputations were classified as Ishikawa zone Ib and 24 as Ishikawa zone II. Seventeen fingers underwent replantation with composite graft plus SDP procedure, whereas the remaining 12 fingers received replantation with composite graft only.
The overall success rate was 70.59% (12 of 17) in the SDP group and 41.67% (5 of 12) in the composite graft-only group ( P = 0.119; odds ratio, 3.36). In the subgroup of Ishikawa zone II fingertip amputations, the success rate was 66.67% (10 of 15) in the SDP group and 22.22% (2 of 9) in the composite graft-only group ( P = 0.035; odds ratio, 7.0).
The SDP procedure could increase the success rate of fingertip replantation with composite graft, especially for Ishikawa zone II amputations.
由于缺乏可用血管，指尖离断的显微外科再植有时会很困难。复合组织移植是一种非血管化再植的替代方法，但成功率有限。提出皮下袋（SDP）手术以提高复合组织移植的存活率。
我们旨在比较应用或不应用SDP手术的复合组织移植在指尖再植中的成功率。
纳入2000年至2020年28例患者的29例指尖离断（28例完全离断，1例近完全离断）。其中5例指尖离断分类为石川I b区，24例为石川II区。17指采用复合组织移植加SDP手术进行再植，其余12指仅采用复合组织移植进行再植。
SDP组总体成功率为70.59%（17例中的12例），单纯复合组织移植组为41.67%（十二例中的5例）（P = 0.119；优势比，3.36）。在石川II区指尖离断亚组中，SDP组成功率为66.67%（15例中的10例），单纯复合组织移植组为22.22%（9例中的2例）（P = 0.035；优势比，7.0）。
SDP手术可提高复合组织移植指尖再植的成功率，尤其是对于石川II区离断。
