Zhou Zhegang, Yu Longbiao, Meng Fanbin, Wen Jingjing, Xiao Yingfeng, Zhou Bo, Wan Shengxiang, Zeng Hui, Yu Fei
Department of Hand & Microsurgery, Peking University Shenzhen Hospital, China.
Department of Orthopedics, Shenzhen Second People's Hospital, China.
JPRAS Open. 2024 Mar 28;40:245-252. doi: 10.1016/j.jpra.2024.03.008. eCollection 2024 Jun.
The fingertip amputation is an amputation type of the finger beyond the proximal nail fold. There is no vein available for anastomoses on the dorsal side of the finger, and the palmar vein of the finger is small and tightly attached to the skin. Therefore, it is relatively difficult to implement surgical anastomoses, which poses challenges to the clinical treatment of fingertip amputations.
A 29-year-old male was admitted to the hospital due to "the amputation of the fingertips of the right index, middle, and ring fingers caused by a heavy object compression 3 h ago". The admission examination revealed that the right index, middle, and ring fingers were completely severed at the 1/2 plane of the nail bed, with irregular sections, severe contusion, and pollution. The X-ray examination showed comminuted fractures of the distal phalanges of the right index, middle, and ring fingers. Based on these findings, the patient was diagnosed with multiple severed fingertips of the right hand (Tamai Zone 1). The patient underwent debridement, vascular exploration, and replantation of the right index, middle, and ring fingertips under emergency general anesthesia. After surgery, anti-inflammatory, spasmolytic, and anticoagulant treatment and regular dressing changes were conducted. The patient did not receive a blood transfusion, and all three fingers survived. The appearance of these fingers was favorable 3 months after surgery, and the flexion and extension of these fingers were normal. Eventually, the patient achieved excellent Chen's hand function scores.
To the best of our knowledge, this may be the first successful case regarding the replantation of three fingertips after amputations in Tamai Zone 1 with favorable outcomes. It can be maintained that super microsurgery can be used for the replantation of multiple fingertip amputations.
指尖离断是指手指离断部位超过近端甲襞。手指背侧没有可供吻合的静脉，且手指掌侧静脉细小并紧密附着于皮肤。因此，实施手术吻合相对困难，这给指尖离断的临床治疗带来了挑战。
一名29岁男性因“3小时前重物挤压致右手示指、中指和环指指端离断”入院。入院检查发现右手示指、中指和环指在甲床1/2平面完全离断，断面不规则，挫伤严重且有污染。X线检查显示右手示指、中指和环指远节指骨粉碎性骨折。基于这些发现，该患者被诊断为右手多发指尖离断（玉井1区）。患者在急诊全身麻醉下行右手示指、中指和环指指端清创、血管探查及再植术。术后进行抗炎、解痉、抗凝治疗及定期换药。患者未输血，三根手指均存活。术后3个月手指外观良好，屈伸正常。最终，患者获得了优秀的陈氏手功能评分。
据我们所知，这可能是首例玉井1区三指离断再植成功且预后良好的病例。可以认为，超显微外科技术可用于多指离断再植。
