Fogdestam I, Hamilton R, Lundborg G
Handchirurgie. 1981;13(1-2):120-5.
A right-handed 4 1/2-year old boy had a sharp amputation 3 cm proximal to his left wrist joint in a hay-cutting machine accident. In addition, he sustained 5 incisions on the anterior and ulnar aspects of the same forearm, the proximal and deepest including radius, ulna and the deep branch of the radial nerve. In a 19 1/2 hours operation, his left hand was replanted and the mainly cold anoxaemia time was 16 hours. Despite several reoperations, the hand could not be saved but the proximal portion of the amputated part did survive. On the 21st day the hand was reamputated at the radiocarpal joint level and the stump closed with viable skin from the proximal 2/3 of the dorsum of the hand. On a 1 year follow-up, the length growth was found to be close to normal. A myoelectric prosthesis is functioning well not only from impulses in the reinnervated extensor muscles but also from the flexor muscles which have been denervated and anatomically divided at least at two levels. Partial replantation success and perfect revascularization and reinnervation in the forearm was gained, thanks to extensive surgery. These results in an extremely complicated injury like this do show that every surgical effort should be made in pediatric extremity trauma.
一名4岁半的右利手男孩在一场割草机事故中，其左手腕关节近端3厘米处被锐器切断。此外，他同一前臂的前侧和尺侧还有5处伤口，近端且最深的伤口累及桡骨、尺骨以及桡神经深支。在一场长达19个半小时的手术中，对其左手进行了再植，主要的冷缺血时间为16小时。尽管进行了多次再次手术，但这只手仍未能保住，不过被切断部分的近端确实存活了下来。在第21天，在桡腕关节水平对这只手进行了再次截肢，残端用手背近端2/3处存活的皮肤进行了闭合处理。在1年的随访中，发现其长度生长接近正常。一个肌电假肢不仅能根据重新获得神经支配的伸肌中的冲动正常运作，还能根据已失去神经支配且至少在两个层面进行了解剖分离的屈肌中的冲动正常运作。由于进行了广泛的手术，在前臂实现了部分再植成功以及完美的血管再通和神经再支配。在这样极其复杂的损伤情况下所取得的这些结果确实表明，对于小儿肢体创伤应尽一切手术努力。
