小儿手指掌侧浅静脉显微解剖及吻合指掌侧浅静脉的断指再植

手指背侧损伤较重的断指再植，因指背静脉挫伤重不能吻合，未节断指无可供吻合的指背静脉，以往将此类断指列为再植之禁忌。我们对４０指小儿尸体手指指掌侧浅静脉进行了显微解剖，在此基础上，临床４０指不能吻合指背静脉的断指实施了吻合指掌侧浅静脉的再植，成活３６指，失败４指，成活率９１％。由于指掌侧浅静脉口径粗，解剖较恒定，吻合后通畅率高。本研究提供了指掌侧浅静脉的显微解剖学数据和临床应用经验。     

腕前臂掌侧浅静脉桥接动脉在断指再植中的应用

自 1993年 6月～ 2 0 0 1年 8月 ,在严重挫伤断指中应用腕前臂掌侧浅静脉桥接动脉的方法进行血运重建 2 9例 ,术后成活 ,外形及功能良好。体会 :本方法再植指体短缩较少 ,能最大限度地保证再植手指的外观。吻合指动脉和切取浅静脉在同一手术区 ,取材方便。腕前臂掌侧血管表浅可见 ,寻找切取时更直观。浅静脉呈线状分布 ,大多有 2～ 4条主支 ,走行直 ,分支少。口径较一致。能确保吻合血管断端质量和适度的血管张力 ,有效防治术后血管危象的发生 ,提高再植成活率。腕前臂掌侧浅静脉桥接动脉在断指再植中的应用$中国人民解放军第九十八医院@俞…     

腕掌侧浅静脉移植在复杂断指再植中的应用

目的 探讨腕掌侧浅静脉移植在复杂断指再植中应用的方法和疗效。方法 对腕掌侧浅静脉进行解剖学观察，并应用此段浅静脉移植，修复复杂断指的血管缺损16例。结果通过解剖学观察，了解腕掌侧存在1～2条较为恒定的浅静脉，其直径与手指固有动脉、指背静相近。对11例伴有血管缺损的复杂断指和5例再植术后血管危象病例，共进行浅静脉移植22指(动脉20条、静脉4条)，优良率达85．0％。结论 腕掌侧浅静脉移植具有位置恒定，直径适宜，取材方便等优点，适合在复杂断指再植中血管移植。     

吻合指掌侧静脉断指再植的研究

目的 为复杂性断指再植血液循环的建立提供新的手术方法。方法 通过新鲜的成人手标本,解剖观测了手指掌侧静脉的分布状态,走向及口径。设计吻合指掌侧静脉断指再植的手术程序及技术方法。     

腕掌侧浅静脉的解剖学观察及临床意义

目的探讨总结腕掌侧浅静脉的解剖学特征和在断指再植中移植的疗效。方法对腕掌侧浅静脉进行系统地解剖学观察,并应用此段浅静脉移植,修复复杂断指的血管缺损19例。结果通过解剖学观察,腕掌侧存在1～2条较为恒定的浅静脉,其直径与手指固有动脉、指背静脉相近。对14例伴有血管缺损的复杂断指和5例再植术后血管危象病例进行浅静脉移植(共25指),优良率达82．6％。结论腕掌侧浅静脉移植具有位置恒定,直径适宜,取材方便等优点,适合在复杂断指再植中血管移植。     

手指多段离断再植的临床研究

目的回顾性分析手指多段离断再植的临床效果。方法对于手指末节、指尖部的断指再植，吻合1条动脉及1条指腹静脉或者吻合1条动脉加拨甲、小切口放血处理，或者行动静脉转流等方法恢复断指血循环；手指中节和近节的离断再植吻合两侧指动脉和2条以上指背静脉，如血管损伤严重，可行浅静脉移植或者邻指动脉移植桥接。结果再植45例81指165段，成活150段，成活率91％。结论手指多段离断再植技术要求高，术中高质量的血管吻合及对血管损伤的有效处理，可以提高断指再植的成活率。加强功能锻炼是再植手指功能恢复的重要环节。     

复杂断指再植中的静脉移植选择

目的 探讨在复杂断指再植中,切取不同部位静脉用于移植修复血管缺损的方法和体会.方法 应用游离腕掌侧浅静脉、游离前臂掌侧浅静脉、游离桡动脉伴行静脉、游离近节指背静脉、游离掌背静脉、游离足背网状静脉的方法修复复杂断指的血管缺损98指（动脉83条,静脉22条）.结果 应用静脉移植修复复杂性断指98指,成活93指,成活率95%.术后随访6个月～3年,根据中华医学会手外科分会断指再植功能评定试用标准,优良率为87%.结论 根据复杂断指缺损血管的部位和长度,切取不同供区静脉进行血管移植,扩大了手术适应证,提高了复杂断指再植成活率,而且取得了良好的外观和功能.     

前臂掌侧浅静脉在拇指旋转撕脱离断再植中的应用

目的 介绍一种血管移植修复拇指旋转撕脱性离断的方法.方法 在旋转离断撕断的断指再植手术中,分别采用同侧前臂掌侧浅静脉移植将离断的拇指动、静脉吻合重建血液循环.结果 再植18例18指,成活17指,坏死1指,再植拇指外观及功能好.结论 前臂掌侧浅静脉具有位置表浅,易于切取,供区损伤小,管径相似于拇指动、静脉,为拇指旋转撕脱性离断血管再植提供可靠的血管供区.     

多指离断再植的探讨

目的 探讨多指离断再植手术中各阶段处理方法，提高各种断指再植的成功率。方法 手指末节、指尖部的断指再植，吻合1条动脉及静脉或者吻合1条动态加拔指甲、小切口放血处理，手指中节断指再植吻合动，静脉比例为1：1，手指近节的距离断再植吻合动、静脉比列1：2或者2：2。如有血管缺损，行浅静脉移植桥接或者邻指动脉移植修复。临床再植58例，142指。结果 再植58例142指中成活129指，成活率90.8%。术后经3个月-3年随访到46例113指。按断指再植评定标准评定，其中优53指，良44指，可14指，差7指，总优良率85.8%.结论 多指离断再植手术时间长,技术要求高。术中高质量的血管吻合及对血管缺损的正确处理，术后血管危象的防治是提高多手指离断再植成功的关键。加强功能锻炼是再植手指功能恢复的重要环节。     

游离静脉皮瓣修复断指伴皮肤和指动脉缺损的疗效分析

目的评价应用前臂或足背静脉皮瓣修复断指伴皮肤和指动脉缺损的疗效。方法对13例断指伴掌侧皮肤、动脉缺损的患者行前臂静脉皮瓣移植8例,足背浅静脉皮瓣移植5例,其中带肌腱重建屈指功能3例,均为一期修复。结果13例静脉皮瓣与再植手指全部成活,外形与功能良好。结论静脉皮瓣一期修复再植手指血管与皮肤缺损操作方法可行,对供区损伤小,成活率高,手指外形好,如伴肌腱缺损．可同时重建手指屈伸功能。     

指掌侧静脉在断指再植中的应用

目的研究吻合指掌侧静脉重建断指血运的方法。方法应用指掌侧静脉重建断指血运27例，其中行指掌侧静脉端端吻合20指，与指背静脉交叉吻合4指，指掌侧静脉动脉化3指。结果25指顺利成活，1例于术后24h发生静脉危象，另1例于术后8h发生血管危象，经二次手术探查，再植手指顺利成活。结论对于利用背静脉重建血运的断指，可行指掌侧静脉端端吻合、与指背侧静脉交叉吻合和远断端静脉动脉化等方式重建手指血运，以提高再植成功率。     

Replantation of amputated finger composite tissues with microvascular anastomosis

Replantation of the partial amputated finger or the composite tissue in finger would achieve better functional and esthetic results than any reconstructive procedure. In this article, we report the results of microsurgical partial finger or composite tissue replantation at different anatomic sites of 24 fingers in 21 patients. Microvascular anastomosis was performed in all cases of replantation. For the digital palmar and lateral composite tissue defects, the proper palmar digital artery and volar or dorsal subcutaneous veins were repaired by end-to-end anastomoses. For the digital dorsal defects, the blood supply was reestablished by arterialization of a dorsal central vein in the replanted part with one of the proper palmar digital arteries. The average follow-up period was 12.3 months. Twenty-two of 24 fingers survived completely with good functional and esthetic results. Two replantations failed because of vascular complications. In conclusion, if the vascular vessels in amputations of partial finger and composite tissue of finger are suitable for anastomosis, a successful replantation of these parts with excellent functional and esthetic recovery can be achieved.     

指尖再植300指的临床研究

目的介绍指尖再植的手术要点。方法对300指指尖离断进行再植,分别采用顺行法或逆行法,尽可能的吻合指动脉及掌侧指静脉。结果本组成活290指,成活率为98%。术后随访6～36个月,指体外形良好,感觉已基本正常,两点辨别觉为3～5mm。结论熟悉指尖部动静脉的解剖和高质量的血管吻合技术是保证再植成功的关键。     

手指末节指掌侧浅静脉的显微解剖及临床应用

目的 研究手指末节指掌侧浅静脉分布规律,指导指末节离断再植术.方法 取100例手指标本分别进行乳胶灌注显微解剖法、断层解剖法、明胶-氧化铅灌注显微-解剖加X线摄片法研究指末节掌侧浅静脉的解剖学特点.临床对10例13指的离断末节指,进行吻合掌侧浅静脉的再植术.结果 在甲根水平通常可以找到1～3条指掌侧浅静脉,管径为0.2～0.5 mm.10例13指末节指离断再植均获成功.术后随访3～18个月,外观功能良好.结论 末节指掌侧浅静脉分布具有规律性,末节指再植吻合掌侧静脉有利于提高再植的成功率,并能减少其他静脉回流方法所带来的并发症.

Abstract：

Objective To study the anatomy of superficial palmar digital veins in fingertip,and explore the clinical application of superficial palmar digital veins as venous drainage in fingertip replantation.Methods One hundred fingers were studied with three methods: microanatomy,sectional anatomy,and X-ray.According to microanatomical observation,thirteen fingers in 10 cases with fingertip amputations and dorsal veins defect were replanted by anastomosis of palmar digital veins to reconstruct the venous drainage of the amputated digits. Results ( 1 ) 1 to 3 tiny superficial palmar digital veins can be found at the level of the onychorrhiza.The average diameters of the superficial palmar digital veins were 0.2-0.5 mm.(2)In clinical practice,13 replanted fingers were survived.After 3-18 months following-up,the appearance and function were satisfactory. Conclusion The distribution of the palmar digital veins was in some pattern.Anastomosis of the superficial palmar digital veins can not only improve the success rate of the fingertip replantation,but also avoid the complications of the other venous drainage methods.     

手指末节指掌侧浅静脉的显微解剖及临床应用

目的 研究手指末节指掌侧浅静脉分布规律,指导指末节离断再植术.方法 取100例手指标本分别进行乳胶灌注显微解剖法、断层解剖法、明胶-氧化铅灌注显微-解剖加X线摄片法研究指末节掌侧浅静脉的解剖学特点.临床对10例13指的离断末节指,进行吻合掌侧浅静脉的再植术.结果 在甲根水平通常可以找到1～3条指掌侧浅静脉,管径为0.2～0.5 mm.10例13指末节指离断再植均获成功.术后随访3～18个月,外观功能良好.结论 末节指掌侧浅静脉分布具有规律性,末节指再植吻合掌侧静脉有利于提高再植的成功率,并能减少其他静脉回流方法所带来的并发症.     

手指末节指掌侧浅静脉的显微解剖及临床应用

目的 研究手指末节指掌侧浅静脉分布规律,指导指末节离断再植术.方法 取100例手指标本分别进行乳胶灌注显微解剖法、断层解剖法、明胶-氧化铅灌注显微-解剖加X线摄片法研究指末节掌侧浅静脉的解剖学特点.临床对10例13指的离断末节指,进行吻合掌侧浅静脉的再植术.结果 在甲根水平通常可以找到1～3条指掌侧浅静脉,管径为0.2～0.5 mm.10例13指末节指离断再植均获成功.术后随访3～18个月,外观功能良好.结论 末节指掌侧浅静脉分布具有规律性,末节指再植吻合掌侧静脉有利于提高再植的成功率,并能减少其他静脉回流方法所带来的并发症.     

Use of volar veins in finger replantation

The number and the location of the venous anastomosis in finger replantation are discussed. The principle: 'two veins for one artery' has been given up in favour to do only one venous anastomosis. A vein on the palmar side should be preferred. Here the anastomosis is protected by a thicker layer of subcutanous tissue. In addition this technique allows to do the total vascular reconstruction without turning the hand. In a number of 84 finger replantations there was a failure rate of 9,5% by using only one vein for replantation. In 17 finger replantations using one volar vein we lost only one finger (5.9%).     

Syndactylizing arterialized venous flaps for multiple finger injuries

Multiple soft tissue finger defects in different shapes and locations are usually difficult to manage. Such defects commonly involve tendons and bones. Palmar soft tissue defects may also lead to vascular compromise. In this retrospective report, we report the results of seven patients with multiple soft tissue finger defects that were covered by syndactylizing arterialized venous flaps. Six of the patients suffered hot‐pressing machine and crushing injuries, one patient had a rolling belt injury. All patients presented with soft tissue defects on palmar or dorsal sides involving at least two digits. The palmar forearm was donor site for all patients. At least one afferent artery and two efferent veins were selected for the anastomosis. Lengths of afferent and efferent veins were long enough to perform healthy anastomosis outside the injury zone. The afferent vessels were anastamosed to the digital arteries with the largest possible diameter or to the common digital arteries to maximize flow. The efferent veins were anastamosed to dorsal veins. Separations of the digits were performed after three weeks by longitudinal incisions. The mean follow‐up period was 12 months. None of our patients suffered a flap loss. Syndactylizing arterialized venous flaps may be used for composite or single tissue reconstruction for multiple finger defects with satisfactory cosmetic and functional outcomes. © 2014 Wiley Periodicals, Inc. Microsurgery 34:527–534, 2014.     

Transient bone resorption following finger replantation: a report of 3 cases

Radiographic changes consisting of alterations in mineral content, osteopaenia or destructive neuropathy that occur following successful finger replantation have already been described. We report our experience about four fingers in three individuals in whom bone changes developed in the first three months postoperatively with complete "restitution ad integrum".Three patients, 21-49 years old (average 36 years) sustained a clean-cut amputation of four fingers. The first patient had an amputation at the base of the middle phalanx of the index finger and the second patient at the base of the proximal phalanx of the ring finger. The third had an amputation at the base of the first metacarpal bone and the proximal phalanx of the small finger in a five finger amputation. In the first case, two dorsal veins and two palmar digital arteries and nerves were repaired. In the second case, one palmar artery and one dorsal vein were reanastomosed. In the third case at the thumb, two dorsal veins and two palmar digital arteries and nerves were reconstructed. At the small finger, one dorsal vein, one palmar digital artery and two digital nerves were reconstructed. Bone fixation was achieved with two and three K-wires or tension-band wiring. Replantation was successful in all cases. Three weeks after replantation, the X-rays showed rapid development of osteopaenia in the juxtaartieular region and metaphyses of the bone. These changes were followed by subperiosteal,intracortical and endosteal bone resorption. No further surgical procedures or splintage were needed and hand therapy was not discontinued. At 10-13 weeks (average 12 weeks)postoperatively, the X-rays showed a complete recovery with new periosteal bone formation.We suggest that the radiographic changes after finger replantation are transient, first evident subperiosteally and progressing centrally. They may reflect small-vessel compromise and microinfarction and transient hyperemia secondary to neurovascular damage or to sympathetic progressive recovery.