Zhang Zhao, Wang Yanyan, Gao Fei, Pan Yuehai, Huang Heng, Lu Chao, Wang Guozhong, Qu Zhigang, Bi Benjun
Department of Hand and Foot Surgery, Affiliated Hospital of Qingdao University, Qingdao Shandong, 266000, P. R. China.
Department of Medical Oncology, Qingdao Central Hospital, University of Health and Rehabilitation Sciences (Qingdao Central Hospital), Qingdao Shandong, 266000, P. R. China.
Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi. 2025 May 15;39(5):628-632. doi: 10.7507/1002-1892.202503002.
To explore the effectiveness of multi-segment inverted Y-shaped vein transplantation using the anterior lateral malleolar venous network for repair of amputated palm injury distal to the superficial palmar arch.
Between September 2018 and July 2023, 5 patients with amputated palm injury distal to the superficial palmar arch were treated. There were 3 males and 2 females with an average age of 35.4 years (range, 29-52 years). The time from injury to admission was 1-6 hours (mean, 3.2 hours). The multi-segment inverted Y-shaped vein transplantation in the anterior lateral malleolar venous network were used to repair the common and proper palmar digital arteries; the another anterior lateral malleolar venous network was used to repair the dorsal vein of the hand. The soft tissue defect of dorsal hand in 1 patient was repaired with the pedicled ilioinguinal flap, and the wound at the donor site was directly sutured. Postoperative treatment included anti-infection therapy, antispasmodic therapy, and thrombosis prevention measures.
The partial necrosis of the fingertip of the thumb occurred in 1 case, and the marginal necrosis of the abdominal flap after operation occurred in 1 case. The remaining fingers showed good blood supply with normal tension. The incision at donor site of the abdominal flap healed by first intention. All patients were followed up 8-41 months (median, 19 months). At last follow-up, the hand contour was satisfactory; the grasping function, opposition function, and proprioception recovered, and two-point discrimination ranged from 5 to 7 mm (mean, 6 mm). According to the upper extremity function evaluation criteria issued by Hand Surgery Society of the Chinese Medical Association, the functional outcomes were excellent in 3 cases, good in 1 case, and fair in 1 case.
The multi-segment inverted Y-shaped vein transplantation using the anterior lateral malleolar venous network for repairing defects in the common and proper palmar digital arteries distal to the superficial palmar arch offers advantages such as superficial location, flexible harvesting, and high compatibility. This technique has demonstrated favorable outcomes in complex transmetacarpal amputation reconstruction.
探讨采用踝前外侧静脉网多节段倒置Y形静脉移植修复掌浅弓远侧手掌离断伤的疗效。
2018年9月至2023年7月，对5例掌浅弓远侧手掌离断伤患者进行治疗。其中男性3例，女性2例，平均年龄35.4岁（范围29 - 52岁）。受伤至入院时间为1 - 6小时（平均3.2小时）。采用踝前外侧静脉网多节段倒置Y形静脉移植修复掌总动脉和指掌侧固有动脉；另一个踝前外侧静脉网用于修复手背静脉。1例患者手背软组织缺损采用带蒂髂腹股沟皮瓣修复，供区伤口直接缝合。术后治疗包括抗感染治疗、解痉治疗和预防血栓形成措施。
1例拇指指尖部分坏死，1例术后腹部皮瓣边缘坏死。其余手指血供良好，张力正常。腹部皮瓣供区切口一期愈合。所有患者均获随访8 - 41个月（中位时间19个月）。末次随访时，手部外形满意；抓握功能、对掌功能和本体感觉恢复，两点辨别觉为5 - 7mm（平均6mm）。根据中华医学会手外科学分会发布的上肢功能评价标准，功能结果优3例，良1例，可1例。
采用踝前外侧静脉网多节段倒置Y形静脉移植修复掌浅弓远侧掌总动脉和指掌侧固有动脉缺损具有位置表浅、取材灵活、相容性高的优点。该技术在复杂掌骨间离断伤重建中显示出良好疗效。
