Duah-Asante Kwaku, Kadhum Murtaza, Khajuria Ankur, Nduka Charles, Koshima Isao, Kannan Ruben Y
Department of Medicine, Imperial College London, London, UK.
Department of Plastic Surgery, Queen Victoria Hospital, East Grinstead, UK.
Plast Reconstr Surg Glob Open. 2023 Jan 25;11(1):e4768. doi: 10.1097/GOX.0000000000004768. eCollection 2023 Jan.
Supermicrosurgery has allowed the replantation/revascularization of the pulp, but how does this currently compare with more proximal digit replantation/revascularization?
In a retrospective case study over a 5-year period at our institute, a total of 21 patients (n = 21) had either finger or pulp replantation-revascularization posttrauma. All pulp replants had a single-vessel anastomosis viz., "artery-to-artery" or "artery-to-vein" only, with venous outflow dependent on the skin-shave technique, while more proximal replants had both arterial and venous anastomoses. Age, sex, ischemic time, handedness, smoker status, and injury-replant interval were compared between the two groups, with all procedures performed by a single surgeon. The outcome parameters studied were length of hospital stay, timeline for wound healing, viability, and functional outcomes.
Our patients consisted of 18 men and three women, of which 14.3% were smokers and 85.7% were right-handed. There were 11 finger replantation/revascularizations (n = 11) versus 10 pulp replantation/revascularizations (n = 10). The average age of digit replantation/revascularization patients was 44.8 years compared with 26.4 years in pulp replantation/revascularization patients (Student test, = 0.04). Mean ischemia time in digital replants was 67 minutes versus 32.3 minutes in pulp replantation/revascularization (Student test, = 0.056). Digital replantation/revascularization was viable in 72% of cases versus a 90% viability in the pulp subcohort.
In our patient cohort, pulp replantation/revascularizations produced better postoperative viability. Where supermicrosurgery expertise is available, pulp replantation/revascularization should be considered a worthwhile option when compared with digital replantation/revascularization.
超显微外科手术已实现牙髓再植/血运重建，但目前它与更近端的手指再植/血运重建相比如何呢？
在我们研究所进行的一项为期5年的回顾性病例研究中，共有21例患者在创伤后进行了手指或牙髓再植 - 血运重建。所有牙髓再植均仅进行单一血管吻合，即“动脉对动脉”或“动脉对静脉”，静脉流出依赖于削薄皮肤技术，而更近端的再植则同时进行动脉和静脉吻合。比较两组患者的年龄、性别、缺血时间、利手、吸烟状况以及损伤至再植间隔时间，所有手术均由同一位外科医生完成。研究的结果参数包括住院时间、伤口愈合时间、存活率和功能结果。
我们的患者包括18名男性和3名女性，其中14.3%为吸烟者，85.7%为右利手。有11例手指再植/血运重建（n = 11）和10例牙髓再植/血运重建（n = 10）。手指再植/血运重建患者的平均年龄为44.8岁，而牙髓再植/血运重建患者为26.4岁（Student检验，P = 0.04）。手指再植的平均缺血时间为67分钟，而牙髓再植/血运重建为32.3分钟（Student检验，P = 0.056）。手指再植/血运重建的存活率为72%，而牙髓亚组的存活率为90%。
在我们的患者队列中，牙髓再植/血运重建术后存活率更高。在具备超显微外科专业知识的情况下，与手指再植/血运重建相比，牙髓再植/血运重建应被视为一个值得考虑的选择。
