文章發表：Plast Reconstr Surg. 2010 Dec;126(6):2043-51.
大綱
一、背景：可以進行指骨遠端與指球的再植，以改善手指的功能和美觀。不過，建立適當的靜脈引流是一個挑戰。已報告顯微外科使用叉狀末端指動脈重新固定部分遠端指骨。分叉分為兩個分支，其中一個用於靜脈引流。在本文中，作者報告了他們使用類似技術的經驗，並提出了一種用於遠端手指再植的新技術。二、方法：從2008年1月至2009年2月，使用一條中央動脈進行了5次再植。再植的水平是牙髓，拇指指尖撕脫和遠端指骨。截肢部位沒有可用的掌側靜脈，背側靜脈或第二條動脈於標準靜脈引流。所有個案的靜脈引流已確立從單個末梢動脈到受體靜脈的分支建造吻合。三、結果：所有手指均成功移植，沒有動脈供血不足或靜脈充血的跡象。五個手指中的任何一個在術後均未發現局部壞死。沒有傷口感染的病例。四、結論：中央單個動脈的分支可在遠端指尖再植下成功重建靜脈流出。在這項研究中，該技術可以挽救所有手指，無需使用水蛭或其他技術於靜脈供血不足的個案。
BACKGROUND:
Replantation of the distal phalanx and pulp can be performed to improve finger function and finger aesthetics; however, establishing adequate venous drainage is a challenge. Slattery et al. reported microsurgical reattachment of a partial distal phalanx with the use of a bifurcated terminal digital artery. The bifurcation was divided into two pedicles, one of which was used for venous drainage. In this article, the authors report their experience with a similar technique and propose a new algorithm for distal finger replantation.
METHODS:
From January of 2008 to February of 2009, five replantations were performed using a single central artery. The replanted levels were pulp, avulsed fingertip of the thumb, and distal phalanges. There was no volar vein, dorsal vein, or second artery available in the amputated part for standard venous drainage. Venous drainage in all cases was established by creating an anastomosis from a branch of the solitary terminal artery to a recipient vein.
RESULTS:
All digits were replanted successfully without evidence of arterial insufficiency or venous congestion. Partial necrosis was not identified postoperatively in any of the five fingers. There were no cases of wound infection.
CONCLUSIONS:
A branch of the central solitary artery may be used successfully to reestablish venous outflow in cases of distal finger tip replantation. This technique allowed for the salvage of all fingers in this study without the use of leeches or other techniques used in cases of venous insufficiency.
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