Morrison W A, Cavallo A V
St Vincent's Hospital, Melbourne, Victoria, Australia.
Ann Plast Surg. 1993 Nov;31(5):467-70. doi: 10.1097/00000637-199311000-00016.
Digital ischemia and cold sensitivity after replantation are common. Occasionally they are severe enough to warrant intervention, including amputation of an otherwise functional digit. We present a patient with pregangrenous ischemia in a replanted thumb 10 years after multiple digit replantation. Angiography revealed vascular occlusion in the distal radial artery with no patent vessel in the thumb. The option of transposition of a spare neurovascular bundle from the adjacent radial digits was limited by their single-vessel supply resulting from previous replantation. We describe a method of revascularization by introduction of an arteriovenous pedicle, using a free fascial flap harvested from the lateral arm and based on terminal ramifications of the profunda brachii vessels. The flap was buried between the pulp and flexor tendon sheath and anastomosed to the radial artery and a wrist vein. This resulted in successful revascularization of the digit, clinically and radiologically, and 20 months later, the patient remains symptom free.
再植术后出现手指缺血和冷敏感很常见。偶尔，这些症状会严重到需要进行干预，包括截除原本功能正常的手指。我们报告一例患者，在多指再植术后10年，其再植拇指出现坏疽前期缺血。血管造影显示桡动脉远端血管闭塞，拇指无通畅血管。由于先前再植导致相邻桡侧手指单血管供血，因此从相邻桡侧手指转位备用神经血管束的选择受到限制。我们描述了一种通过引入动静脉蒂进行血管重建的方法，使用从侧臂获取的游离筋膜瓣，该筋膜瓣以肱深血管的终末分支为蒂。将该皮瓣埋置于指腹与屈肌腱鞘之间，并与桡动脉和腕静脉吻合。这在临床和影像学上均实现了手指的成功血管重建，20个月后，患者仍无症状。
