De Francesco Francesco, Mani Olimpia, Gravina Pasquale, Riccio Michele
Department of Reconstructive Surgery and Hand Surgery, Azienda Ospedaliera Universitaria delle Marche, 60126 Ancona, Italy.
J Clin Med. 2024 Aug 29;13(17):5120. doi: 10.3390/jcm13175120.
: A continuous obstacle that has limited access to and implementation of finger replantation surgery is timeliness, as ischemia time is traditionally considered a crucial factor for success. However, claims that the vitality of amputated fingers decreases after 6 h of warm ischemia and 12 h of cold ischemia are mostly based on theoretical considerations. : Here we present a case of multi-digit revascularization after 72 h of warm ischemia using the microsurgical arteriovenous bypass technique. : In the reported case, revascularization was performed after a long ischemic period and showed good recovery of motor and sensory function. : We identified significant limitations in the literature supporting time limits of ischemia and recent evidence demonstrating the feasibility of delayed finger replantation. The current treatment approach for amputation injuries often requires transfers or nighttime emergency procedures, increasing costs and limiting the national availability of finger replantation. Changes to finger replantation protocols based on evidence could expand access to this service and improve the quality of care.
一直以来，限制手指再植手术开展和实施的一个持续存在的障碍是及时性，因为传统上缺血时间被视为成功的关键因素。然而，关于断指在热缺血6小时和冷缺血12小时后活力下降的说法大多基于理论考量。在此，我们报告一例采用显微外科动静脉旁路技术在热缺血72小时后进行多指再血管化的病例。在所报告的病例中，在长时间缺血期后进行了再血管化，运动和感觉功能恢复良好。我们发现支持缺血时间限制的文献存在重大局限性，以及近期有证据表明延迟手指再植是可行的。目前针对截肢损伤的治疗方法通常需要转运或夜间急诊手术，增加了成本并限制了手指再植在全国范围内的可及性。基于证据对手指再植方案进行调整可以扩大这项服务的可及性并提高护理质量。
