Matsusue Takeo
Department of Plastic Reconstructive Surgery, Kansai Electric Power Hospital, Osaka, Japan.
Arch Plast Surg. 2024 Feb 28;51(1):118-125. doi: 10.1055/a-2190-8487. eCollection 2024 Jan.
Tamai zone 4 replantation, defined as the replantation at a level proximal to the flexor digitorum superficialis' insertion and distal to where the common digital artery branches into the proper digital artery, has poor functional results because making orthosis and rehabilitation protocols that protect the bone and the flexor and extensor tendons simultaneously difficult. Two cases of Tamai zone 4 replantation are presented: one case of an index finger replantation at the proximal phalanx and a case of ring finger replantation at the proximal interphalangeal joint. The author did not repair the flexor tendon intentionally in the primary replantation and performed two-stage flexor tendon reconstruction later. The total active motions (TAMs) at the last follow-up were 215 and 180 degrees, respectively, with the latter distal interphalangeal joint being an arthrodesis. Both cases had no extension lag in the proximal interphalangeal joint. These results were much better than those in previous reports, in which the mean TAM was 133 degrees or less. The good results appeared to be mainly due to the reasonable and clear postoperative rehabilitation protocols made by the proposed procedure. This procedure may be useful for obtaining reproducible functional results even in Tamai zone 4 replantation.
玉井4区再植术，定义为在指浅屈肌止点近端、指总动脉分支为指固有动脉处远端的水平进行再植，其功能结果较差，因为同时制作保护骨骼以及屈肌腱和伸肌腱的矫形器和康复方案很困难。本文介绍了两例玉井4区再植术病例：一例为食指近节指骨再植，另一例为环指近侧指间关节再植。作者在一期再植时故意未修复屈肌腱，随后进行了两期屈肌腱重建。末次随访时的总主动活动度（TAM）分别为215度和180度，后者远侧指间关节为关节融合术。两例患者近侧指间关节均无伸展滞后。这些结果比之前以前报告报告中的结果要好得多，之前报告中的平均TAM为133度或更低。良好的结果似乎主要归功于所提出的手术方法制定的合理且明确的术后康复方案。即使在玉井4区再植术中，该手术方法对于获得可重复的功能结果可能也是有用的。
