共查询到20条相似文献,搜索用时 156 毫秒
1.
目的 介绍旋转撕脱性拇指离断再植方法的疗效及临床应用价值.方法 回顾性分析38例旋转撕脱性拇指离断的再植体会.采用桡动脉-拇指远端拇主要动脉吻合、桡神经浅支-拇指远端尺掌侧指固有神经接合、头静脉及桡动脉伴行静脉-拇指背侧静脉吻合、食指固有伸肌腱代替拇长伸肌腱、环指屈指浅肌腱代替拇长屈肌腱进行拇指再植术.结果 38例拇指再植指体全部成活.随访2个月~2年,再植指恢复良好.按中华医学会手外科学会上肢部分功能评定使用标准评定,获得较满意疗效.结论 经血管、神经、肌腱转位的方法施行旋转撕脱性拇指离断的再植,成活率高,术后感觉与运动功能恢复较理想,减少手术次数. 相似文献
2.
3.
前臂掌侧浅静脉在拇指旋转撕脱离断再植中的应用 总被引:1,自引:1,他引:0
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. 相似文献
4.
5.
目的 探讨拇指旋转撕脱性离断再植的临床治疗方法及疗效.方法 对28例拇指旋转撕脱性离断患者,采用环指浅屈肌腱转位修复拇长屈肌腱,重建拇指屈曲功能,食指固有伸肌腱转位修复拇长伸肌腱,重建拇指伸指功能,环指桡侧指动脉、神经修复拇指指动脉、神经,食指指背静脉修复拇指静脉.结果 术后28例再植拇指全部成活.随访1~6年,再植拇指屈伸功能及外形恢复满意,两点辨别觉为5~9 mm.根据中华医学会手外科学会手功能评定试用标准,综合评价全部为优良.结论 此种转位方法对拇指旋转撕脱性离断再植,术后功能恢复满意,是一种安全有效的治疗方法. 相似文献
6.
7.
8.
<正> Pho于1979年对拇指撕脱性断指再植首先报道。国内学者对拇指、食指、环指旋转撕脱性断指再植均有过报道,但文中报道的再植方法及成活率各有不同。我们自1990年以来对79例79指旋转撕脱性拇指离断实施再植,成活76指,成活率762%。23例经2个月~3年随访,再植拇指获得了满意的外形和功能。现报道如下。 1 临床资料 本组79例79指,男55例,女24例,年龄最大59岁,最小6岁。指别:左手拇指27例,右手拇指52例。受伤原因:各种丝绳、绞带伤19例,钻床伤21例,其它机器伤39例。离断平面:指间关节平面23例,掌指关节平面39例,腕掌关节平面17例。伤情及手术情况:79例均为完全性离断。3例动脉从远端撕脱,神经、肌腱从近端撕脱,采用远端静脉动脉化,食指尺侧动脉神经转移,顺利成活。50例动脉、神经肌腱从近端抽出,挫 相似文献
9.
旋转撕脱性完全离断断腕再植 总被引:1,自引:1,他引:0
目的探讨旋转撕脱性完全离断断腕再植改进手术方法的效果。方法在11例旋转撕脱性完全离断断腕再植术中,9例采用改进的方法再植:①腕关节固定前,拇指首先置于外展对掌位固定。②肌腱的处理采用肌腱移位方法,首先修复具有重要功能的肌腱;部分肌腱采用编织法缝合。③对于血管的修复,吻合腕掌侧浅静脉、桡动脉、尺动脉伴行静脉;提前吻合动脉。④剪开腕管并剪除部分腕掌侧横韧带。结果11例再植断腕均成活,随访1~3年,感觉及运动功能恢复参照2000年3月中华医学会手外科学会断指再植功能评定试用标准,优4例,良5例,可2例。优良率81.8%。结论旋转撕脱性完全离断断腕再植术改进后的手术方法具有术后虎口挛缩程度轻,拇指对掌功能恢复好,肌腱粘连程度轻等优点。 相似文献
10.
中指尺掌侧动脉转位在拇指旋转撕脱离断再植中的应用 总被引:3,自引:3,他引:0
目的介绍一种拇指旋转撕脱性离断的再植方法。方法断指静脉分别采用静脉直接吻合、邻指静脉转位和示指背侧静脉蒂岛状皮瓣转位修复;断指动脉均用中指尺掌侧动脉转位吻接拇指尺掌侧动脉进行修复。结果13例13指成活11指,坏死2指。再植拇指外观及功能好。结论中指尺掌侧动脉解剖恒定、口径较粗、切取后对指功能和血运影响小;其转位修复断指动脉只一个吻合口、旋转角度小及有足够的可利用长度,是一种有效的拇指旋转撕脱性离断再植方法。 相似文献
11.
Kuang-Te Chen Yi-Chieh Chen Samir Mardini Fu-Chan Wei 《British journal of plastic surgery》2005,58(6):869-872
Replantation of digits following avulsion amputation is a challenge due to the severity of damage to the digital vessels. When the digital vessels are absent or severely injured, standard artery-to-artery or vein-to-vein anastomoses may be impossible and arteriovenous shunting can be used as a salvage procedure for arterial inflow or venous drainage. Previous cases of successful replantation of avulsed digits that were reperfused using afferent arteriovenous shunting reported small segments of tissues only, usually at the level of the distal phalangeal joint or distal to it. Our case demonstrates that afferent arteriovenous shunting can also provide adequate perfusion to a large piece of tissue in the thumb even when the amputation level is at the interphalangeal joint. 相似文献
12.
A retrospective study of 130 digital replantations was analyzed to identify factors influencing success rates. At the amputation between the middle phalanx and distal interphalangeal joint, it was found that type of injury and number of anastomosed vessels and veins were the most important factors. Amputations caused by mechanical crush reduced the number of available vessels for anastomoses. Having an anastomosed artery without any anastomosed vein significantly reduced the success rate compared with cases of amputation by knife or sawing machine, where at least an artery and a vein could be anastomosed. In replantation at the distal phalanx, only one anastomosed artery without any anastomosed vein could also result in high success. And in most cases of amputation between the proximal phalanx and proximal interphalangeal joint, there was no difficulty in finding at least an artery and a vein. Knowledge of anatomical transitions is therefore important for surgeons. 相似文献
13.
Wagner A Garrido I Ferron G Chevreau C Lafosse JM Grolleau JL Chavoin JP 《Annals of plastic surgery》2007,59(3):344-348
Melanoma management requires consideration of both oncologic and reconstructive principles to optimize both the likelihood of cure and quality of life. The plastic surgeon is encountering melanoma management that requires not only oncologic but also reconstructive surgery while considering both esthetic and functional results. Management of acrolentiginous melanoma typically involves the partial amputation of the thumb or the toe, with removal of the distal phalanx and the adjacent interphalangeal joint. The simple partial amputation of the second phalanx, preserving the pulp and the interphalangeal function (joints and tendinous insertions), and a made-to-measure ungual transfer provide excellent functional and esthetic results while maintaining similar oncologic outcomes. This report attempts to clarify the management of melanoma of the thumb. 相似文献
14.
Adani R Marcoccio I Tarallo L Fregni U 《Techniques in hand & upper extremity surgery》2005,9(1):42-46
In the past 12 years, 16 thumb defects at, or distal to, the interphalangeal joint were reconstructed using a great toe mini wrap-around flap. A flap including the entire nail and most of the distal phalanx of the great toe was used. Fifteen of the grafts survived. The sensory recovery of the reconstructed thumb was good as assessed by 2-point discrimination test with an average of 10 mm (range 5-15), and there were no complaints of cold intolerance. This technique results in good cosmetic appearance, and all patients were pleased with the cosmetic aspect of the thumb and there was no significant morbidity at the great toe donor site. The final decision to reconstruct a distal thumb amputation is influenced by gender, job, and age of the patients. The great toe mini wrap-around flap is an excellent reconstruction technique in selected patients. 相似文献
15.
16.
PURPOSE: The purpose of this study was to introduce the technique for distraction lengthening of the traumatic amputation stumps of distal phalanges less than 10 mm long by using the Ilizarov minifixator (Ito Medical Instruments, Tokyo, Japan) and to report the treatment results and the problems we encountered. METHOD: Six patients (3 men and 3 women) underwent lengthening of the traumatic amputation stumps of distal phalanges using the Ilizarov minifixator. The mean pre-operative length of the distal phalanges was 6.0 mm and the mean deficiency in length was 9.5 mm compared with the contralateral finger or thumb. RESULTS: In 5 of the 6 patients callus lengthening was completed without early consolidation or bone failure related to the traction wires. The mean gain in lengthening of the distal phalanx was 6.8 mm and the mean final length of the distal phalanx was 12.8 mm. After surgery 4 patients had onychoplasty and advancement flap coverage of the distal phalangeal tip because of excessive skin tension and 1 patient had arthrodesis because of flexion contracture of the distal interphalangeal joint. The patients were satisfied with the cosmetic improvement of their fingertips. CONCLUSIONS: Although this callus distraction method required multiple surgical procedures it is considered worthy of more frequent application especially in young patients. 相似文献
17.
Chien-Tzung Chen Fu-Chan Wei Hung-Chi Chen Chwei-Chin Chuang Hung-Tang Chen Wen-Ming Hsu 《Microsurgery》1994,15(1):77-82
Microsurgical replantation has been attempted in the distal phalanx of the digits. Twenty-three complete, single digit amputations are reviewed. The patients' ages ranged from 9 months to 48 years. Viability was 78%. Sensory recovery averaged 7 mm static two-point discrimination. Range of motion in the distal interphalangeal joint of the finger and the interphalangeal joint of the thumb averaged 64 and 51 degrees, respectively. Eight of the 17 successfully replanted digits had mild to moderate atrophy. Eighty-two percent of patients were able to use the replanted digit successfully in their daily work. We feel that distal digital replantation is rewarding. In successful cases, it always preserves acceptable function and good appearance at a price of an average of 2.3 months off work. © 1994 Wiley-Liss, Inc. 相似文献
18.
Osteosynthesis in digital replantation using bioabsorbable rods 总被引:2,自引:0,他引:2
There are several fixation techniques for osteosynthesis in digital replantation. Kirschner wire fixation is used commonly but the wires protrude and disturb mobilization. Moreover, it requires removal. Since February 1995, the authors have been using a bioabsorbable rod made of poly-L-lactide as an intramedullary nail for osteosynthesis in digital replantation. The advantages of this technique include the absence of protruding hardware that would require removal and technical simplicity. This method has been applied for 15 arthrodeses (12 distal interphalangeal joints, 1 proximal interphalangeal joint, and 2 interphalangeal joints of the thumb) and for 11 diaphysis fractures (5 proximal, 5 middle, and 1 distal phalanx). All patients were observed until there was clinical and radiographic evidence of fusion (average interval to fusion, 8.4 wk). Bone resorption occurred in one patient. There were no cases of nonunion or infection. Poly-L-lactide rod fixation is a simple and effective technique. 相似文献
19.
Omer Ozkan H Ege Ozgenta? Tun? Safak Ozlenen Dogan 《Journal of plastic, reconstructive & aesthetic surgery》2006,59(5):451-459
Although ring avulsion injuries are not common, when they do occur their management is still a challenging problem in reconstructive surgery. In this report, we present our microsurgical experiences with Kay's class III and IV ring avulsion injuries. A total of six patients with ring avulsion injuries were operated on between 2000 and 2004. Three patients were in class III with inadequacy of both arterial and venous circulation, and the remaining three were in class IV. The study consisted of four male and two female patients whose ages ranged from 23 to 43 (mean age 32). Average ischaemic time was 2.2 h (range 1-4 h). The ring finger was involved in all cases and microsurgical repair was performed using axillary block anaesthesia. The bone was detached at the level of the distal interphalangeal joint and soft tissues at the proximal phalanx level with the preserved proximal interphalangeal joint and flexor digitorum superficialis tendon in all cases. Because the zone of injury is more extensive, we debrided the avulsed digital artery over a long distance, and used long interpositional vein grafts radically in all patients. Venous drainage was accomplished by performing at least two vein anastomoses using vein grafts when necessary. Both digital nerves were repaired primarily after debridement. Results indicated that microsurgical repair had a success rate of 100%. The authors conclude that microsurgical reconstruction of ring avulsion injuries with intact proximal interphalangeal joint and flexor digitorum superficialis tendon yields superior results, both functionally and aesthetically, even in complete amputation. 相似文献
20.
Ring avulsion replantation is a technically challenging procedure with a very low success rate. Because the zone of arterial injury is more extensive than what it appears to be in such avulsion amputations, a technique was developed to debride the avulsed digital artery for a long distance, extending well into the digital pulp, thereby creating healthy arterial ends to be bridged by one or two segments of long venous grafts. Using this technical approach, 7 patients with complete amputations of ring avulsion injury (Urbaniak's class III) were operated. In all amputations the bone was disrupted at the distal interphalangeal level (except in 1 patient) and the soft tissues at the proximal phalanx level, with the proximal interphalangeal joint and the flexor digitorum superficialis tendons being intact. Results indicated that replantation was successful in all patients. However, 2 patients presented with unusually late arterial failure 28 and 30 days after surgery respectively. Although one of these cases was salvaged by reoperation, the other case (followed by conservative management) demonstrated partial distal necrosis. Therefore, the ultimate success rate in this series was 85% in the long term. At follow-up, sensibility was protective in all patients, with an average static two-point discrimination of 7.8 mm (range, 6-14 mm). The total active motion of the replanted digits was 194 deg on average (range, 155-205 deg) without loss of function of the proximal interphalangeal joint except in 2 patients who had late vascular problems. The authors conclude that microsurgical replantation of completely amputated ring avulsion injuries with an intact proximal interphalangeal joint and flexor digitorum superficialis tendon, is a worthwhile procedure that results in good functional and aesthetic results. Furthermore, using an aggressive approach for debridement of the avulsed digital artery, as described in this article, an experienced microsurgeon can replant successfully nearly all cases. However, one should be cautious in the follow-up of such patients, because late arterial failure may be encountered, as was observed in 2 patients in this series. The authors suggest immediate reoperation in such unusual circumstances. 相似文献