目的 探讨吻合弓上动脉的儿童指尖离断再植技巧及其临床效果。 方法 2020年1月至2022年9月，对苏州瑞华骨科医院小儿骨科收治的62例62指儿童甲根部平面以远指尖完全离断进行再植，所有动脉断裂平面均位于动脉弓以远的弓上动脉处，弓上动脉口径在0.15~0.35 mm之间，术中均成功吻合弓上动脉，术毕及时通血，对术后坏死病例进行原因分析，对成活病例采取门诊复诊、微信、电话相结合的方式进行定期随访，随访内容包括指体饱满度、指骨间关节自主活动度、指甲生长情况、瘢痕增生情况以及再植指体对针刺的反应情况，并按断指再植功能评定试用标准进行临床效果评定。 结果 术后指体成活56例，其中2例术后发生伤口感染，经加强伤口换药及应用敏感抗生素后再植指体成活。坏死6例，其中2例行坏死指体解脱后远侧指骨间关节平面残端修整，4例因指体较小，坏死后予伤口换药，最终痂下愈合。52例获得随访（包括2例感染后换药成活病例及4例坏死后痂下愈合病例），10例失访（包括2例坏死后行残端修整病例），随访时间为2~30个月，平均6个月，再植指体外形、功能恢复良好；按断指再植功能评定试用标准评定：优44指，良6指，中2指。 结论 儿童指尖弓上动脉纤细，只要方法应用得当，均可以吻合，对于该平面的离断伤，再植术后疗效满意，临床上应尽量选择再植手术。 Objective To investigate the techniques of digit-tip replantation with anastomosis of superior digital arch artery in children and to evaluate the clinical effects. Methods From January 2020 to September 2022, 62 children (62 digits) with completely severed digit-tips were admitted to the Department of Paediatric Orthopaedics, Suzhou Ruihua Orthopaedic Hospital. All the injury planes were distal to the nail root. All arterial dissections were distal to the digital arterial arch with the vessel calibre from 0.15 mm to 0.35 mm. The superior arch arteries of the digital arterial arch were successfully anastomosed. After surgery, a significant blood flux to the replanted digit body were observed. Postoperative necroses or failures were analysed for the causes. All children with survived digit-tips were entered into scheduled follow-ups through a combination of visit of outpatient clinics or via WeChat and telephone reviews. Postoperative follow-up included digit body fullness, motion of distal interphalangeal joint, nail growth, scarring, and response of the replanted digit-tips to needling. Clinical outcomes were evaluated according to the evaluation criteria for finger replantation function. Results Of the 62 replanted digit-tips, 56 survived after replantation. Two digits had wound infection after surgery, and survived by dressing change and applying sensitive antibiotics. Necrosis occurred in 6 replanted digit-tips, of which 2 necrotic digit bodies were amputated, and the stumps at the distal interphalangeal joint were repaired. The other 4 necrotic digits were healed after dressing change under the scab due to a smaller digit body. A total of 52 children (including 2 survivals from postoperative infection after dressing changes and 4 survivals with healing underneath-eschar after necrosis) and with 10 lost during follow-up (including 2 with stump repairs after necrosis). The follow-up period ranged from 2 to 30 months, with an average of 6 months. The shape and function of replanted digit-tips recovered well. According to the evaluation criteria for finger replantation function, 44 digits were of excellent, 6 of good, and 2 of fair. Conclusion In children, the superior arch arteries of digital arterial arches of the digit-tips are small in diameter. However, the vessels in smaller calibres can be anastomosed, should proper surgical techniques are applied. Therefore, due to the satisfactory outcomes, microsurgeons should try the best efforts to replant a digit severed at the plane of digit-tip.
Abstract
Objective To investigate the techniques of digit-tip replantation with anastomosis of superior digital arch artery in children and to evaluate the clinical effects. Methods From January 2020 to September 2022, 62 children (62 digits) with completely severed digit-tips were admitted to the Department of Paediatric Orthopaedics, Suzhou Ruihua Orthopaedic Hospital. All the injury planes were distal to the nail root. All arterial dissections were distal to the digital arterial arch with the vessel calibre from 0.15 mm to 0.35 mm. The superior arch arteries of the digital arterial arch were successfully anastomosed. After surgery, a significant blood flux to the replanted digit body were observed. Postoperative necroses or failures were analysed for the causes. All children with survived digit-tips were entered into scheduled follow-ups through a combination of visit of outpatient clinics or via WeChat and telephone reviews. Postoperative follow-up included digit body fullness, motion of distal interphalangeal joint, nail growth, scarring, and response of the replanted digit-tips to needling. Clinical outcomes were evaluated according to the evaluation criteria for finger replantation function. Results Of the 62 replanted digit-tips, 56 survived after replantation. Two digits had wound infection after surgery, and survived by dressing change and applying sensitive antibiotics. Necrosis occurred in 6 replanted digit-tips, of which 2 necrotic digit bodies were amputated, and the stumps at the distal interphalangeal joint were repaired. The other 4 necrotic digits were healed after dressing change under the scab due to a smaller digit body. A total of 52 children (including 2 survivals from postoperative infection after dressing changes and 4 survivals with healing underneath-eschar after necrosis) and with 10 lost during follow-up (including 2 with stump repairs after necrosis). The follow-up period ranged from 2 to 30 months, with an average of 6 months. The shape and function of replanted digit-tips recovered well. According to the evaluation criteria for finger replantation function, 44 digits were of excellent, 6 of good, and 2 of fair. Conclusion In children, the superior arch arteries of digital arterial arches of the digit-tips are small in diameter. However, the vessels in smaller calibres can be anastomosed, should proper surgical techniques are applied. Therefore, due to the satisfactory outcomes, microsurgeons should try the best efforts to replant a digit severed at the plane of digit-tip.
关键词
指尖离断/弓上动脉/再植/血管口径/儿童
Key words
Severed digit-tip/Superior digital arterial arch/Replantation/Vascular calibre/Child
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