文章發表：Ann Plast Surg. 2010 Mar;64(3):286-90.
大綱
缺血耐受性一直是手及手指再植過程中的主要問題。由於多次轉診，局部缺血有時會超過24小時以上。截肢會減低被截肢者的活動效能；因此，如果有良好的再植機會，可以進行顯微外科再植手術挽救患處功能。在1998年至2006年間，有14名患者在長時間缺血超過24小時後進行了25次再植。在這14名患者中，有12名在外院拇指再植失敗後轉診到我院急診室，包括2名拇指截肢再植失敗術後，10名多指截肢再植失敗術後。2名患者因手腕截肢引起嚴重休克，在重症加護病房觀察並損傷風險控制復甦，待控制出血過多及生命徵穩定象後，第二天進行了兩手再植。在這項研究中，成功再植了16次，失敗9次；因此，成功率為64.0％。重建部位的活動機能修復需要一些輔助過程。缺血時間對於挽救肢體至關重要。手及手指的肌肉組織很少。因此，即使超過24小時的長時間缺血也可以進行這些部位的再植以恢復手部功能。
Ischemia tolerance has been a major concern during hand and finger replantation. Because of multiple referrals and damage control resuscitation, ischemia is occasionally prolonged for more than 24 hours. Amputation impairs functional efficiency in amputees; therefore, if there is a favorable indication for replantation, microsurgical replantation can be performed to salvage the function of the affected part to an acceptable extent.Between 1998 and 2006, 14 patients underwent 25 replantations after prolonged ischemia of more than 24 hours. Of the 14 patients, 12 were referred to our hospital after unsuccessful replantations and admitted to the emergency room. Two of these patients underwent thumb amputations, and 10 patients underwent multiple digit amputations. Two patients underwent wrist amputation with associated polytrauma and profound shock, both hand replantations were performed on the following day after ICU management with damage control resuscitation was performed to control excessive bleeding and stabilize vital signs.In this study, 16 replantations were successful and 9 failed; thus, the success rate was 64.0%. Several secondary procedures were required for restoring the functional ability of the reconstructed parts.Ischemia time is critical for limb salvage. Hands and fingers have very little muscle tissue. Hence, replantation of these parts can be performed even in the case of prolonged ischemia to restore the hand function.
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