Kim W K, Lim J H, Han S K
Department of Plastic and Reconstructive Surgery, Korea University College of Medicine, Seoul, Korea.
Plast Reconstr Surg. 1996 Sep;98(3):470-6. doi: 10.1097/00006534-199609000-00017.
From July 1985 to February 1993, 135 digits in 119 patients with complete amputations at or distal to the distal interphalangeal joint (zone I for amputations distal to the nail base of zone II for amputations between the distal interphalangeal joint and the nail base) were replanted using a microsurgical technique at Korea University Guro Hospital. Because of the high social value placed on body form and function, the indication for replantation was extended to cases with severe soft-tissue injuries and attempted replantation as a routine procedure in nearly all distal amputation cases. The overall survival rate was 78 percent, with the survival rate for zone I being 70 percent and that for zone II reaching 86 percent. Even in cases with severe soft-tissue injury, the survival rate was high, with viability in avulsion injuries and crush injuries reaching 75 percent each. The most common type of vascular repair in zone I cases was revascularization of one artery only and no vein repair (87 percent). Of these cases, interpositional vein grafts were used in 65 percent. In zone II cases, the most common combination repair was one artery and one vein anastomosis (70 percent), with interpositional vein grafts for arterial anastomosis in 49 percent; most of the venous repair was feasible by the direct method (78 percent). The follow-up period ranged from 1 month to 5 years with a mean of 14.8 months; 52 patients were followed-up for more than 6 months. In 52 long-term follow-up patients, the average two-point discrimination was 8 mm. Patient satisfaction, aesthetically and functionally, was high (91 percent).
1985年7月至1993年2月，韩国大学古罗医院采用显微外科技术，为119例在指间关节或其远端完全离断（Ⅰ区为甲床远端的离断，Ⅱ区为指间关节与甲床之间的离断）的患者再植了135个手指。由于身体外形和功能具有较高的社会价值，再植的适应证扩展到严重软组织损伤的病例，并且几乎对所有远端离断病例都作为常规手术尝试进行再植。总体成活率为78%，Ⅰ区成活率为70%，Ⅱ区成活率达86%。即使在严重软组织损伤的病例中，成活率也很高，撕脱伤和挤压伤的成活均达到75%。Ⅰ区病例最常见的血管修复类型是仅对一条动脉进行血运重建且不进行静脉修复（87%）。在这些病例中，65%使用了静脉移植。在Ⅱ区病例中，最常见的联合修复是一条动脉和一条静脉吻合（70%），49%在动脉吻合时使用了静脉移植；大多数静脉修复可通过直接法完成（78%）。随访期为1个月至5年，平均14.8个月；52例患者随访超过6个月。在52例长期随访患者中，平均两点辨别觉为8毫米。患者在美观和功能方面的满意度较高（91%）。
