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FORWARD HOMODIGITAL ULNARIS ARTERY FLAP COVERAGE FOR BONE AND NAIL BED GRAFT IN THUMB FINGERTIP AMPUTATION

Objective To approach a new procedure of microsurgery to repair thumb fingertip amputation with forward homodigital ulnaris artery flap coverage for bone and nail bed graft. Methods From March 2005 to October 2007, 6 cases of amputated thumb fingertip (6 fingers) were treated, including 4 males and 2 females and aging 23-63 years. Six patients’ (3 crush injuries, 2 cut injuries and 1 other injury) amputated level was at nail root (2 cases), mid-nail (3 cases), and the distalone third of nai bed (1 case). The time from injury to surgery was 3-10 hours, they were treated with forward homodigital ulnaris artery flap coverage for bone and nail bed graft. The flaps size ranged from 1.5 cm × 1.4 cm to 2.0 cm × 1.4 cm. Results All flaps survived. Wound healed in one-stage in 5 cases, and healed in second stage in 1 case because of swell ing. All skin grafting at donor site survived in one-stage. All patients were followed up for 6-8 months. The appearance of flaps were good, and the two-point discrimination was 5-6 mm. Bone graft were healed, the heal ing time was 4-5 weeks. All finger nails were smooth and flat without pain. Conclusion When there was no indication of replantation in thumb fingertip amputation, establ ishing the functional and esthetic construction can be retained with forward homodigital ulnaris artery flap coverage for bone and nail bed graf

帽状原位缝合结合筋膜瓣移位治疗无再植条件的指尖离断伤

目的总结帽状原位缝合结合筋膜瓣移位治疗无再植条件的指尖离断伤疗效。 方法2011年6 月－2012年1月，收治9例甲床中段平面以远的指尖离断伤患者。男6例，女3例；年龄12～60岁，平均42岁。致伤原因：机器绞伤3例，压砸伤6例。损伤指别：拇指3例，示指2例，中指3例，小指1例。受伤至入院时间为3～8 h，平均5 h。显微镜下探查明确无再植条件后，采用局部筋膜瓣移位结合帽状缝合治疗；对甲床缺损者同期行甲床扩大术。 结果术后回植指体均成活，创面Ⅰ期愈合。患者均获随访，随访时间6～15个月，平均8个月。患指指端无触痛，指腹饱满，指纹恢复。指端感觉恢复良好，末次随访时两点辨别觉为8～10 mm，远侧指间关节主动活动度0～60°。指甲生长良好，较正常略小。 结论对无再植条件的指尖离断伤，帽状原位缝合结合筋膜瓣移位治疗具有手术操作简便、回植指体成活率高、功能及外形可靠的优点。

神经端侧吻合术在拇指旋转撕脱离断伤中的应用

目的 总结拇指旋转撕脱离断再植中指神经端侧吻合的修复方法及临床疗效。 方法 2007 年8 月－2009 年10 月，收治9 例离断平面位于掌指关节附近的拇指旋转撕脱离断伤患者。男5 例，女4 例；年龄20 ～ 46 岁，平均25.7 岁。机器损伤7 例，钢丝勒伤2 例。损伤至入院时间为1 ～ 6 h。对拇指再植术中指神经行端侧吻合修复。 结果 术后切口均Ⅰ期愈合，9 例再植拇指均顺利成活。患者均获随访，随访时间6 ～ 12 个月。拇指外形良好，均恢复痛、温觉，指腹两点辨别觉为9 ～ 12 mm，感觉均恢复至S3+ ～ S3。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：优5 指，良4 指，优良率100%。 结论 掌指关节附近平面拇指旋转撕脱伤采用指神经端侧吻合修复，拇指可以获得良好感觉，且外形与功 能恢复较好。

指血管神经肌腱移位一期再植治疗拇指旋转撕脱离断

目的总结拇指旋转撕脱离断一期再植方法及疗效。 方法2011年6月－2013年9月，收治10例机器绞伤致拇指旋转撕脱离断患者。男9例，女1例；年龄18～48岁，平均36岁。左手2例，右手8例。均为机器绞伤。受伤至入院时间3～12 h，平均6 h。离断平面：近指间关节水平4例，近节指骨基底水平4例，掌指关节水平2例。取环指桡掌侧神经动脉束修复拇指指掌一侧神经动脉束，取手背桡侧静脉移位修复离断拇指静脉，并同时取环指屈指浅肌腱及示指固有伸肌腱重建拇长屈、伸肌腱。 结果术后再植拇指均成活。患者均获随访，随访时间8～30个月，平均18个月。再植拇指外形良好，指腹饱满；术后6个月末节指腹两点辨别觉为5～9 mm，平均7.2 mm。末次随访时，再植拇指功能根据中华医学会手外科学会上肢部分功能评定试用标准：获优7例，良3例，优良率100%。环指伸屈活动良好，无手指萎缩，未出现手指苍白等表现，切取侧指腹感觉均为S3。 结论对于拇指旋转撕脱离断，可采用单侧神经动脉束及肌腱移位一期再植，术后可早期进行再植拇指功能锻炼，并获得较好疗效。

CLINICAL EXPERIENCE OF RETROGRADE REPLANTATION FOR AMPUTATED TOE

ObjectiveTo summarize the clinical experience of the retrograde replantation for amputated toe. MethodsBetween January 2010 and August 2015, 11 cases of amputated toes (15 toes) were treated by the retrograde replantation. All patients were male, with a mean age of 31 years (range, 18-45 years). The causes included cutting injury in 6 cases (9 toes) and crush injury in 5 cases (6 toes). One case had amputated great toe and distal segment of the second toe combined with the third toe nail bed contusion; 1 case had amputated proximal great toe and middle segment of the second and third toes; 1 case had amputated proximal segment of great toe and middle segment of the second toe; 7 cases had amputated distal segment of the great toe; and 1 case had amputated middle segment of the fifth toe. The time from injury to hospital was 1-3 hours (mean, 2 hours). ResultsThirteen toes survived completely after operation. Toe necrosis occurred in 1 toe; partial dorsal skins necrosis and nail bed necrosis occurred in 1 toe, and was cure after repaired with dorsalis pedis island flap. The rate of success for replantation of amputated toes was 93.33% (14/15). X-ray examination showed fracture healing of all survival toes at 8-12 weeks after operation (mean, 10 weeks); internal fixation was removed. Eleven cases were followed up 3-12 months (mean, 7.5 months). The survival toes had good appearance and toenail. The two point discrimination was 9-12 mm (mean, 10 mm) at last follow-up. The patients could walk and run normally. ConclusionIt is an ideal surgical method to use retrograde replantation to treat amputated toe, with the advantages of simple operation and high survival rate.

指端离断伤的修复探讨

阴茎旋转撕拉离断一期异位寄养二期再植一例

火车伤中髋部辗压离断创面的修复

报道火车伤中髋部辗压离断创面修复68例的诊治经验。根据损伤创面不同类型，采用带蒂皮瓣或肌皮瓣修复30例，自体游离植皮33例，自体、异体联合植皮5例。创面Ⅰ期愈合42例，感染16例，死亡10例。认为凡皮下组织破坏的皮肤和间隙纵形分离的肌肉均应彻底清创切除，转移的皮瓣或肌皮瓣应注意潜在的血管挫伤。

CLINICAL EFFICACY OF NON-MICROSURGICAL TREATMENT FOR MOSTLY-ISOLATED FINGER WITH ITS BILATERAL ARTERIA INJURY

OBJECTIVE: To explore a method to treat the mostly-isolated finger with its bilateral arteria injury without microsurgery. METHODS: To avoid exacerbating iatrogenically the wound, the methods of therapy mainly included the following procedures: debriding carefully, suturing the cutis and subcutaneous layer to fix internally the fracture without Kirschner wire, and not suturing the broken finger nerve or the broken tendon which had rebound. It was used in the emergency operation. After operation, heat therapy and Anisodamine were used to dilate capillary and micrangium of the unbroken soft tissue of the wounded finger, which was anatomically the only base of blood supply of pars of the wounded finger. RESULTS: In the 34 cases, main blood supply of the wounded finger was restored. The wound healed well in 28 cases. In 6 cases of necrosis in the edge of the wound, the necrosis were excised and the cicatricial healing was achieved. In 31 patients followed up, after the fracture had healed, the nerve and tendon were repaired. CONCLUSION: The methods above should be available for the mostly-isolated finger, especially in a hospital without microsurgery.

逆行指动脉背侧支三叶皮瓣修复手指末节毁损型离断伤

目的 总结逆行指动脉背侧支三叶皮瓣修复手指末节毁损型离断伤的手术方法和临床效 果。 方法 2004 年 8 月－ 2008 年12 月，收治 22 例23 指末节毁损型离断伤患者。男 16 例17 指，女 6 例 6 指；年龄12 ～ 67 岁，平均36 岁。撕脱伤11 例11 指，压砸伤9 例10 指，爆炸伤2 例2 指。示指9 指，中指7 指，环指5 指，小指2 指。缺损平面均在中节指骨以远，缺损长度1.1 ～ 2.3 cm。受伤至手术时间为30 min ～ 8 h。术中采用范围为4.6 cm ×0.6 cm ～ 6.1 cm × 2.2 cm 的逆行指动脉背侧支三叶皮瓣修复。供区植皮修复。 结果 术后3 例皮瓣出现静脉危象，经换药愈合；其余皮瓣及供区植皮均顺利成活，切口Ⅰ期愈合。16 例16 指获随访，随访时间6 ～ 25 个月，平均16.5 个月。皮瓣质地柔软，外观饱满，无臃肿，指端无触痛。皮瓣两点辨别觉为6 ～ 10 mm。术后6 个月手功能按总主动活动度法评定，优9 指，良6 指，可1 指，优良率93.8%。 结 论 逆行指动脉背侧支三叶皮瓣修复手指末节毁损型离断伤手术简便、安全，疗程短，是一种较为理想的方法。