热压伤致小儿手指离断再植  

Replantation of severed fingers in children caused by thermal compression injury

作　　者：庞晓阳[1] 吴攀峰[1] 卿黎明[1] 周征兵[1] 俞芳[1] 曾磊[1] 肖勇兵[1] 潘丁[1] 唐举玉[1] Pang Xiaoyang;Wu Panfeng;Qing Liming;Zhou Zhengbing;Yu Fang;Zeng Lei;Xiao Yongbing;Pan Ding;Tang Juyu(Department of Hand Microsurgery,Xiangya Hospital,Central South University,Changsha 410008,China)

机构地区：[1]中南大学湘雅医院手显微外科,长沙410008

出　　处：《中华手外科杂志》2020年第4期247-249,共3页Chinese Journal of Hand Surgery

基　　金：湖南省自然科学基金(2018JJ2640)。

摘　　要：目的探讨热压伤致小儿手指离断再植的手术方法和适应证。方法自2014年12月至2019年11月,对热压伤所致4例9指小儿手指离断采用显微外科技术进行再植。清创后采用克氏针行指骨纵行固定,修复指屈、伸肌腱,吻合两侧指动脉及伴随神经,并吻合指掌侧静脉或取静脉移植重建指背静脉,指背热压伤皮肤予暂时保留或一期皮瓣覆盖指背创面。结果术后1例小指发生静脉危象,拆除部分伤口缝线,侧切放血成功存活,余指体均完全存活。术后随访0.5~1.0年,根据中华医学会手外科学会上肢部分功能评定试用标准综合评定手功能:优2例,良1例,可1例。结论热压伤所致小儿手指离断,只要指体完整,术中综合判断皮肤、血管、骨损伤的程度,通过吻合指动脉及指掌侧静脉,或取静脉行指背静脉移植,局部带蒂皮瓣覆盖创面再植术后效果满意。Objective To explore the surgical methods and indications of replantation of severed fingers in children caused by thermal compression injury.Methods From December 2014 to November 2019,4 cases of 9 fingers amputation caused by thermal compression injury were replanted by microsurgery technique.After debridement,we used Kirschner wire to fix the phalanges vertically,repaired the flexor and extensor tendons of fingers,anastomosed the arteries and accompanying nerves on both sides of fingers,anastomosed the palmar vein of fingers or took the vein to reconstruct the dorsal vein of fingers.The thermal compression injuried skin of the dorsal finger was temporarily preserved or the dorsal digital wound was covered with flap at one-stage.Results One case of venous crisis occurred in the little finger after operation.Part of the wound sutures were removed,and the side cutting and bleeding were successful,and the rest of the fingers survived completely.The patients were follow-up for 0.5 to 1.0 year.According to the evaluation criteria of upper limb function of Hand Surgery Society of Chinese Medical Association,2 cases were excellent,1 case was good,and 1 case was fair.Conclusion For the amputation of fingers in children caused by thermal compression injury,as long as the finger is intact,the degree of skin,blood vessel and bone injury can be comprehensively judged during the operation.The satisfactory results can be achieved after replantation by anastomosis of digital artery and ventral vein or transplantation of dorsal digital vein and the local pedicled flap covering the wound.

关 键 词：儿童 再植术 热压伤 断指 

分 类 号：R726.8[医药卫生—儿科]