原位回植加压敷裹治疗指端复合组织离断伤  

Use of in situ suturing and pressure dressing technique for the treatment of the fingertip amputation

作　　者：王亮[1] 郭恩琪[1] 谢庆平[1] 许新伟[1] 晋培红[1] 范奔[1] 

机构地区：[1]浙江省人民医院手外科,浙江杭州310014

出　　处：《实用手外科杂志》2011年第1期12-14,共3页Journal of Practical Hand Surgery

摘　　要：目的 介绍原位缝合加压敷裹法治疗指尖离断伤.方法 本组32例（32指）,手指受伤机制均为锐性损伤,均为指尖平面完全离断,并伴有指骨、指甲及甲床损伤,伤指均无法再植.创面面积：0.3cm×1.3cm～0.5cm×2.0cm.清创后,用5/0无损伤缝线间断原位缝合离断指体,并加压敷裹固定,术后10d拆除加压包,3周创缘拆线.结果 成活29指,成活率90.6%.术后随访36个月,伤指与健侧长度基本相等,指尖外形和颜色良好,指甲生长良好,局部无压痛.痛温觉及精细感觉恢复较好.结论 当指尖离断无法再植时,采用原位缝合加压敷裹修复伤指不失为一种有效的治疗措施.Objective To introduce the treatment of the fingertip amputation by using in situ suturing and pressure dressing technique. Methods Thirty-two amputated fingertips in 32 patients were treated in our center. The mechanism of the injury was sharp injury associated with bone and nail bed exposure. In all digits, performance of vessel anastomosis was impossible due to more distal level of amputation. The wound was measured to be from 0.3cm×1.3cm to 0.5cm×2.0cm in size. After debridement, the amputee was sutured in situ with interrupted 5/0 suture and secured with tie-over pressure dressing. Ten days after surgery, the tie-over dressing was removed. The suture was removed 3 weeks after surgery. Results Complete survival of the amputated part was observed in 29 of 32 digits with the survival rate of 90.6%. The patient whose amputated part was survived returned for assessment. At the final follow-up （range, 3 to 6 months）, the contour of the fingertip was restored. The length of the injured digit was similar to that of the contralatera] side. Nail growth was also observedl The appearance and color of the injured fingertip were similar to those of the contralateral side. Fingertip tenderness was not noted. The sensation of the fingertip and range of motion of the injured finger were acceptable.Conclusion In situ suturing and pressure dressing is a useful and reliable technique for the treatment of the fingertip amputation, when digital replantation is impossible.

关 键 词：指尖损伤 原位缝合术 加压敷裹 断指 

分 类 号：R658.2[医药卫生—外科学]