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指侧方静脉在指尖离断再植中的应用

目的 介绍吻合指尖区侧方静脉重建回流行指尖离断再植的方法。 方法2009年3月－2011年12月，收治36例（42指）指尖离断患者。男20例（24指），女16例（18指）；年龄15～40岁，平均24.5岁。受伤原因：绞轧伤4例（4指），压砸伤6例（7指），电锯伤8例（8指），切割伤18例（23指）。离断指别：拇指3指，示指10指，中指15指，环指10指，小指4指。指尖分型：Ⅰ型19指，Ⅱ型5指，Ⅲ型11指，Ⅴ型7指。受伤至手术时间90 min～6 h，平均3.6 h。再植术中采用吻合侧方静脉重建回流，共吻合指侧方静脉80条，吻合动脉53条。 结果再植指尖均成活，无回流障碍发生，切口均Ⅰ期愈合。患者均获随访，随访时间6～24个月，平均14.5个月。指尖外形、功能恢复满意，指体无明显萎缩，39指指甲生长接近平整，3指指甲呈脊样生长。术后6个月根据1975年美国手外科学会推荐的手指总主动活动度（TAM）系统评定方法评定：优39指，良3指，优良率100%。 结论指尖离断再植中通过吻合侧方静脉可有效重建静脉回流。

REPAIRING DEGLOVING INJURY OF DISTAL PHALANX WITH HOMODIGITAL BILOBED FLAPS TILED

Objective To study the methods and effectiveness of repairing degloving injury of the distal phalanx with homodigital bilobed flaps tiled. Methods Between April 2008 and June 2011, 40 patients (40 fingers) with degloving injury of the distal phalanx were treated, which were caused by machine. There were 30 males and 10 females, aged from 18 to 56 years(mean, 30 years). The time from injury to operation was 1-5 hours (mean, 2.5 hours). Affected fingers included index in 13cases, middle finger in 11 cases, ring finger in 9 cases, and l ittle finger in 7 cases. The defect area ranged from 3.0 cm × 2.0 cm to 5.5 cm × 3.8 cm. All cases complicated by pollution and exposure of tendon and phalanx, 5 cases by phalangeal fractures, and tendon insertion had no rupture. The end dorsal branches of digital artery island flaps and digital arterial island flaps were used in 14 cases, the end dorsal branches of digital artery island flaps and near dorsal branches of digital artery island flaps in 18 cases, and the end dorsal branches of digital artery island flaps and superficial palmar digital veins arteril ization island flaps in 8 cases. The area of the upper flaps ranged from 2.0 cm × 1.5 cm to 2.6 cm × 2.2 cm and the area of the next leaf flaps ranged from 2.5 cm × 2.0 cm to 3.5 cm × 2.5 cm. The donor sites were covered with free flaps. Results Flap bl ister occurred in 13 cases and vascular crisis in 3 cases. The flaps survived in 40 cases, wound healing by first intention was achieved in 38 cases, and by second intention in 2 cases. The donor skin-grafting was survival. After operation, 30 patients were followed up 8 to 20 months with an average of 10.6 months. The flaps had satisfactory appearance and soft texture, and the finger tip had no touch pain. The sensory function of the flaps was restored at 4-6 weeks after operation; two-point discrimination was 6.0 to 10.0 mm in 24 flaps at 12-15 months. According to the total active movement (TAM) evaluation system introduced by the American Society for Surgery of the Hand in 1975, the results were excellent in 27 cases, good in 2 cases, and fair in 1 case, and the excellent and goodrate was 96.7%. Conclusion The homodigital bilobed flaps tiled for degloving injury of the distal phalanx is simple and easyto- operate with less injury.

机器人胃癌手术镜下吻合技术