足趾移植手指再造术血管危象的防治

目的 探讨术前评估、术后处理在足趾移植手指再造术血管危象防治中的作用.方法 回顾1995-2007年间,我院收治的203例236指再造手术的患者,提出了术前、术中、术后各个环节防治血管危象的必要性,分析血管危象发生的时间、性质以及不同的处理和转归,比较2004年后针对性术前处理(多普勒超声检测及低分子肝素钠抗凝治疗)对减少血管危象发生的影响.结果 足趾移植再造术后41指发生血管危象,其中19指经保守治疗后,危象缓解,再造指全部存活;手术探查22指,成活21指,失败1指.总成活率达99.6%.2004年后收治的123指再造术,经针对性术前处理后,术后血管危象发生率为12.2%,较之2004年以前的23.0%有明显的降低.结论 提高足趾移植拇、手指再造的成活率,关键在于如何减少血管危象的发生.严谨的手术设计,把握术前、术中、术后三个环节的处理是降低血管危象发生的重要因素,积极手术探查则可以有效地提高成活率.

Prevention and treatment of vascular crisis in toe-to-finger transplantation

Objective To discuss the effect of preoperative evaluation and postoperative management in preventing eirculation crisis after toe-to-thumb and toe-to-finger transplantation. Methods Two hundred and thirty-six fingers/thumbs of 203 patients that were reconstructed with free toe transfer in our hospital from 1995 to 2007 were reviewed.The necessity of circulation crisis prevention in every aspect of pre-,intra-and postoperative management was looked into.The time,features.different treatment methods and results of circulation crisis were analyzed.The effectiveness of specific preoperative management(Doppler ultrasound examinations,low molecular weight heparin for anticoagulation)in reducing circulation crisis after 2004 was also evaluated. Resuits Circulation crisis OCCUlTed in 41 fingers after toe transfer.It was alleviated by nonoperative treatment in 19 fingers.All these transplants survived eventually.Twenty-two fingers of circulation crisis underwent surgical exploration.Twenty-one of those survived and 1 failed.The survival rate was 99.6%.For the 123 fingers that were operated after 2004 and managed by specific preoperative treatment,the rate of postoperative circulation crisis was 12.2%.which was significantly lower compared to the 23.0%before 2004(P＜0.05). Conclusion The key to improve the survival rate of toe-to-finger transfer lies in how to reduce the occurrence of circulation crisis.Precise operation designs and proper management before.during and after the operation are important factors.When cireulation crisis occurs.prompt surgical exploration can effectively increase the survival rate.