Pitzler D, Buck-Gramcko D
Ann Chir Gynaecol. 1982;71(1):19-27.
104 secondary operations after 76 successful replantations in the upper limb in 49 patients have been evaluated. Of 150 successful replantations in 106 patients this represents an incidence of secondary procedures of 50.6%. 28.5% for skin cover, 18.6% on nerves, 17.6% on joints, 7.4% on bones and 3.9% on vessels. 1.5% of secondary operations were for removal of materials used for bone fixation. The most frequent operations on the individual structures in relation to level of amputation and the interval after replantation have been described. The inference that the number of reconstructed vessels influences the number of secondary operations can at least be drawn from the figures for skin cover for the finger as a whole, but not for the other structures. From the metacarpus proximally, no relationship could be demonstrated between vessels anastomosed and secondary procedures. An association between type of injury and incidence of secondary operations could be demonstrated. The so-called "unfavourable" slicing injuries. It was remarkable that circular saw and crush injuries, usually regarded as "unfavourable", necessitated fewer further operations than slicing injuries. Equally unexpected was the finding that secondary operations were most frequent not in the oldest age groups but in the group aged between 10 and 20. The type of injury can be excluded as a reason for this. No satisfactory explanation can be given.
对49例患者上肢76次成功再植后的104次二次手术进行了评估。在106例患者的150次成功再植中，二次手术的发生率为50.6%。皮肤覆盖手术占28.5%，神经手术占18.6%，关节手术占17.6%，骨骼手术占7.4%，血管手术占3.9%。1.5%的二次手术是为了取出用于骨固定的材料。描述了与截肢水平和再植后间隔相关的各个结构最常见的手术。至少从整个手指皮肤覆盖的数据中可以推断出，重建血管的数量会影响二次手术的数量，但其他结构并非如此。从近端掌骨开始，吻合血管与二次手术之间没有相关性。可以证明损伤类型与二次手术发生率之间存在关联。即所谓的“不利”切割伤。值得注意的是，通常被认为“不利”的圆锯伤和挤压伤比切割伤需要的进一步手术更少。同样出乎意料的是，二次手术最频繁的并非年龄最大的人群，而是10至20岁的人群。损伤类型不能作为对此的解释。无法给出令人满意的解释。
