改良动脉静脉化在无静脉吻合甲根部以远离断再植中的应用  

Application of modified arterial venalization in replantation of distally severed finger at nail root withoutvenous anastomosis

作　　者：赵建军 谢振军 孙华伟 梁正洋 张建华 Zhao Jianjun;Xie Zhenjun;Sun Huawei;Liang Zhengyang;Zhang Jianhua(Department of Hand and Foot Microsurgery,Henan Provincial People's Hospital,People's Hospital of Zhengzhou University,Zhengzhou 450003,China)

机构地区：[1]河南省人民医院郑州大学人民医院手足显微外科,郑州450003

出　　处：《中华手外科杂志》2019年第6期412-414,共3页Chinese Journal of Hand Surgery

摘　　要：目的介绍一种改良的手指甲根部以远离断再植中重建静脉回流的方法,并探讨其临床效果。方法自2016年1月至2018年9月,我们对12例13指甲根部以远离断伤患者进行断指再植,所有病例两断端均无可供吻合的静脉,将近端双侧指固有动脉与远端指动脉或2个分支吻合,一侧指动脉于吻合口近端切断,并将其与近端指背静脉吻合,建立静脉回流。结果再植13指中1指因组织挫伤严重部分坏死,其余12指均完全存活,术后无静脉危象发生。术后随访时间为3?9个月,平均6.0个月,再植指皮肤质地良好,指甲生长良好,感觉恢复至5以上,患者对外形及功能满意。结论改良动脉静脉化能有效解决静脉缺乏时的静脉回流问题.提高甲根部以远离断再植的成活率,是断端静脉缺乏时重建静脉回流的一种有效方案。Objective To introduce an improved method of reconstructing venous reflux in replantation of distally severed finger at nail root,and explore its clinical efficacy.Methods From January 2016 to September 2018,12 patients with 13 distally severed fingers at nail root were replanted.There were no veins to anastomose the two severed ends.The proximal bilateral proper digital artery was anastomosed with the distal digital artery or two branches.The proximal digital artery was cut off and anastomosed with the proximal dorsal digital vein to establish venous reflux.Results In 13 replanted fingers,1 finger had partial necrosis due to serious tissue contusion,and the other 12 fingers survived completely.No venous crisis occurred after operation.The postoperative follow-up time ranged from 3 to 9 months with an average of 6.0 months.The skin texture of replanted finger was good,the nail grew well,and the sensation recovered to over S3.The patient was satisfied with the appearance and function.Conclusion The modified arterial venalization can effectively solve the venous reflux problem in venous deficiency and improve the survival rate of replantation of distally severed finger at nail root.It is an effective way to reconstruct venous reflux in the absence of severed veins.

关 键 词：再植术 治疗结果 动脉静脉化 静脉回流 

分 类 号：R65[医药卫生—外科学]