非常规静脉吻合方式重建IshikawaⅡ区断指再植回流  

Reconstruction of venous drainage of finger replantation in Ishikawa areaⅡby unconventional venous anastomosis

作　　者：程贺云[1] 巨积辉[1] 唐林峰[1] 赵强[1] 王本元 罗少秋 朱柯烨 Cheng Heyun;Ju Jihui;Tang Linfeng;Zhao Qiang;Wang Benyuan;Luo Shaoqiu;Zhu Keye(Department of Hand Surgery,Ruihua Hospital Affiliated to Suzhou University,Suzhou 215104,China)

机构地区：[1]苏州大学附属瑞华医院手外科,苏州215104

出　　处：《中华手外科杂志》2021年第2期99-101,共3页Chinese Journal of Hand Surgery

基　　金：苏州市科教兴卫-青年科技项目(KJXW2019073)。

摘　　要：目的探讨非常规静脉吻合方式重建IshikawaⅡ区断指再植静脉回流的临床疗效。方法自2010年1月至2019年6月,我们对70指IshikawaⅡ区完全离断患者进行再植术,术中因无指背皮下静脉吻合,采用非常规静脉吻合方式重建静脉回流,其中吻合指腹静脉77条,吻合指侧方静脉86条,吻合甲床静脉12条。结果本组70指,其中66指未出现血管危象,术后无需湿敷放血治疗,指体血运良好,一期顺利存活;4指出现静脉危象,予甲床或指端小切口肝素棉球湿敷放血治疗,1指存活、3指坏死。再植成活率95.7%。存活指体术后随访时间为5~47个月,平均11.3个月,再植指体血供良好,皮肤质地良好,外形饱满。46指指甲生长良好,13指轻微畸形,8指畸形明显或生长不全。感觉恢复均S3以上,两点分辨觉为3~8 mm。按中华医学会手外科学会断指再植功能评定试用标准评定67指存活指体:优59指,良8指;优良率100%。结论了解IshikawaⅡ区断指静脉分布规律,采用非常规静脉吻合方式重建静脉回流,可明显提高再植指体成活率,恢复良好的外观及功能。Objective To investigate the clinical efficacy of unconventional venous anastomosis in reconstruction of venous drainage in Ishikawa areaⅡreplantation.Methods From January 2010 to June 2019,70 completely severed fingers of Ishikawa areaⅡwere replanted.Because there was no dorsal subcutaneous vein anastomosis,unconventional venous anastomosis was used to reconstruct venous drainage.Among them,77 digital ventral veins,86 digital lateral veins and 12 nail bed veins were anastomosed.Results Among the 70 fingers,66 fingers did not have vascular crisis,no need of wet compress and bloodletting treatment after operation.The blood supply of fingers was good,and they achieved primary survival successfully.And 4 fingers with venous crisis were treated with heparin cotton ball wet compress and bloodletting through nail bed or fingertip small incision.1 finger survived and 3 fingers died.The survival rate of replantation was 95.7%.The average follow-up time was 11.3 months(range,5 to 47 months).The replanted fingers had good blood supply,good skin texture and full appearance.46 fingernails grew well,13 had slight deformity,and 8 had obvious or incomplete growth.The sensory recovery was above S3,and the two-point discrimination was 3 to 8 mm.According to the evaluation standard of replantation function of severed fingers issued by Hand Surgery Society of Chinese Medical Association,59 fingers were excellent and 8 fingers were good,and the excellent and good rate was 100%.Conclusion To understand the distribution of veins in Ishikawa areaⅡand reconstruct venous drainage by unconventional venous anastomosis can significantly improve the survival rate of replanted fingers and restore good appearance and function.

关 键 词：指损伤 再植术 静脉吻合 静脉回流 

分 类 号：R658.1[医药卫生—外科学]