Kim W K, Lee J M, Lim J H
Department of Plastic and Reconstructive Surgery, Guro Hospital, Korea University College of Medicine, Seoul, Korea.
Plast Reconstr Surg. 1996 Sep;98(3):477-84. doi: 10.1097/00006534-199609000-00018.
Amputations involving nine and all ten digits are very rare because of the different lengths of the digits, and it is also unusual to have all digits suitable for replantation. At Korea University Guro Hospital, from March 1987 to April 1992, three cases of 10-digit and five cases of 9-digit complete amputations were replanted by microsurgical technique. All eight cases involved young, healthy male patients, and the causes of amputation were either a cutter of press machine. The replantations were done under general anesthesia simultaneously on both hands by eight microsurgeons divided into a total of four teams. The operating times ranged from 19 to 31 hours, and the total amounts of transfused blood ranged from 6 to 38 pints. The warm ischemic times ranged from 10 minutes to 15 hours, and the cold ischemic times ranged from 3 to 29 hours. The sequence of replantation was radial digit to ulnar digit. In five of the eight patients, all of the replanted digits survived. Necrosis occurred in one and two digits in two patients with nine-digit replantations. Also, necrosis occurred in three digits in a patient who had had nine digits amputated by a press machine, sustaining severe crush injuries. The overall survival rate was 92 percent. In multidigit replantations involving 9 or 10 digits, there are a number of problems that must be overcome, including a long operating time, long ischemic times, and a large amount of blood loss. The long ischemic times were not critically related to survival rate. The total amount of blood transfused was reduced from 38 pints in one of the initial cases to 6 pints by intermittent use of the pneumatic tourniquet and venous anastomosis before arterial anastomosis. Static two-point discrimination ranged from 3 to 22 mm, and palm to pulp distance ranged from 0 to 7 cm, 1 to 5 years postoperatively. Grasping power ranged from 13 to 65 lb, and pinching power ranged from 5 to 26 lb, which was 42 and 50 percent of the average power of a Korean adult male, respectively. All eight patients returned to work and are satisfied with the result, functionally and aesthetically.
由于手指长度不同，涉及九指和十指全部离断的情况非常罕见，而且所有手指都适合再植的情况也不常见。在高丽大学九老医院，从1987年3月至1992年4月，采用显微外科技术对3例十指和5例九指完全离断进行了再植。所有8例均为年轻健康男性患者，离断原因均为冲压机切割伤。再植手术由8名显微外科医生分为4组，在全身麻醉下同时对双手进行。手术时间为19至31小时，输血量为6至38品脱。热缺血时间为10分钟至15小时，冷缺血时间为3至29小时。再植顺序为从桡侧手指到尺侧手指。8例患者中有5例所有再植手指存活。9指再植的2例患者中，分别有1指和2指发生坏死。此外，1例因冲压机致9指离断并伴有严重挤压伤的患者，有3指发生坏死。总体存活率为92%。在涉及9指或10指的多指再植中，有许多问题必须克服，包括手术时间长、缺血时间长和大量失血。较长的缺血时间与存活率并无密切关系。通过在动脉吻合前间歇性使用气动止血带和静脉吻合，初始病例之一的输血量从38品脱减少至6品脱。术后1至5年，静态两点辨别觉范围为3至22毫米，掌指距范围为0至7厘米。握力范围为13至65磅，捏力范围为5至26磅，分别为韩国成年男性平均力量的42%和50%。所有8例患者均已重返工作岗位，对功能和外观方面的结果感到满意。
