邻指静脉皮瓣移位断指异位再植一例

邻指静脉皮瓣移位断指异位再植一例王利病例男，２６岁。左手压轧伤１小时入院。检查：左手示、中、环指自近侧指间关节部完全离断。示指断端近侧背部皮肤连同指背静脉一起撕脱至掌指关节部，伸肌腱外露。离断之残指毁损，无法再植。中指背侧皮肤尚存，掌侧皮肤缺损至掌指...     

示指旋转撕脱性离断7例再植体会

我科自1987年以来，收治示指旋转撕脱性离断伤7例，全部再植成活，报告如下。1临床资料1．1一般情况本组男5例，女2例。年龄16～34岁。左侧3例，右侧4例。离断手面：示指近节基）＆5例，掌指关节2例。肌胜抽出长度：伸肌腱4～12cm，屈肌腱12～25cm；指动脉、神经抽出长度1～7cm，指静脉0．2～3cm。伤后至手术时间：3～8h。7例全部成活，随访0．5～4年，示指指间关节伸屈幅度10°～90°，掌指关节融合者30°～90°，修复神经的分布区皮肤触、痛、温觉恢复良好，两点分辨距离6～12mm。1．2再植方法在离断平面以近5cm处剪断断指的肌腱，用肥皂…     

断指再植中皮肤,血管缺损20例处理体会

1993年以来,我们采用邻指皮瓣转移及微小静脉皮瓣移植等方法,治疗皮肤、血管同时缺损的断指再植20例20指,再植指全部成活,外观及功能满意。1　临床资料1.1　一般情况　本组男14例,女6例;年龄17～45岁。电锯伤8例,挤压断离伤5例,旋转撕脱伤4例,爆炸伤3例。拇指断离4例,示指断离8例,中指断离6例,环指断离2例。掌侧皮肤缺损12例,背侧皮肤缺损8例,皮肤缺损面积1.0cm×1.5cm～2.5cm×3.0cm。带指动脉的邻指皮瓣转移6例,静脉皮瓣移植14例。断指及皮瓣全部成活,手指外观及功能恢复满意。1.2　手术方法　常规肥皂水刷洗伤口周围皮肤及1∶3000氯己定(…     

手指旋转撕拉断离特点与再植方法选择

手指旋转撕抢断离后，由于血管神经肌位皮肤从近端不同平面抽断，伤情极为复杂，再植相当困难。我们在1881指再植的基础上，进行了旋转撕拉断指再植的研究，报告如下。临床资料本组52例53指中，男36例37指，女16例！6指。年龄6～54岁（平均26．7岁）。其中完全断离引指，不完全断离2指。再植成活49指，成活率92．5酿。再植部位：拇指34个，食指8个，中指5个，环指3个，小指3个。再植平面：掌指关节18指，近节18指，近指间关节7指，中节1指，远指间关节9指。肌胜向远端抽出长度：（l）伸指肌键：小于scm33指，5～10cml4指，10～20cm3指，20～…     

手指残端修整91例体会

我科1992年2月～1997年2月收治手指外伤性毁损73例85指,断指再植失败18例18指,共91例103指行残端截指术。经彻底清创合理处理残端及指神经,术后随访6个月～5年,仅1例出现指神经假性神经瘤,取得了满意效果。1　临床资料1.1　一般情况　本组男66例,女25例。拇指2例,示指18例,中指25例,环指21例,小指20例,示、中、环指1例,中、环、小指1例,环、小指2例,中、小指1例。1.2　致伤原因　机器绞伤47例,石块击伤29例,船浆击伤4例,车祸伤8例,刀砍伤3例。1.3　术中处理　术中彻底清创后,对45个残指神经行快刀切割,24个残指神经行外膜缝合,21个残指神经…     

断指再植83例静脉吻合方法改进体会

1987年以来,我们采用吻合指掌侧浅静脉代替吻合指背浅静脉,共进行断指再植83例97指,成活92指,成活率94.8%,效果满意。1　临床资料1.1　一般情况　本组83例,男67例,女16例,平均28.3岁。均为完全离断,其中拇指21指,示指33指,中指20指,环指19指,小指4指。离断平面:近节19指,近侧指间关节23指,中节38指,远侧指间关节及远节17指。指掌侧固有动脉与指掌侧浅静脉吻合比例1∶1者15指,1∶2者43指,2∶2者16指,2∶3者23指。1.2　手术方法　我们改变了传统的再植程序〔1〕,以吻合指掌侧浅静脉代替吻合指背浅静脉。再植顺序为:(1)断指清创;(2)骨固定、修…     

足部游离静脉皮瓣在断指合并软组织缺损再植中的应用分析

目的探讨足部游离静脉皮瓣用于断指合并软组织缺损再植中的临床效果。方法 2014—2017年鹤壁市人民医院显微外科收治28例手指离断且接受足部游离静脉皮瓣移植修复的患者,男性21例,女性7例;年龄17~55岁,平均37.0岁。其中拇指3例,食指12例,中指5例,环指4例,小指4例,多为断指与手指近节基底部完全断裂且无组织连接,同时离断指体完整,并伴有血管、神经缺损。依据患处的缺损形状设计出比缺损面积大10%的静脉皮瓣,皮瓣轴线需与静脉走向一致。沿设计大小切开皮肤、皮下,于皮瓣深筋膜层游离皮瓣,在皮瓣游离结束后,将切取的远近端静脉倒置移植于患指,桥接固有动脉与指背静脉。若远端指体皮色渐好,皮缘渗血则获得血供,即血管吻合通血,可直接缝合。不能缝合的情况可取上臂内侧或腹股沟处皮片进行植皮。手术完成后将引流皮片置于皮瓣下。结果 28例再植断指及指静脉皮瓣全部成活,运动功能满意。结论足部游离静脉皮瓣应用在断指合并软组织缺损再植中操作简单便捷,成活率高且供区损伤小。     

手指背侧静脉缺损时的断指再植

手指指背皮下组织少,皮肤滑动度小,而掌侧皮下组织多。手指受伤时指背静脉易损伤,特别是扭转挤压伤,而掌侧或侧面静脉损伤较轻,故指背静脉缺损多或找不到时,可以利用掌侧静脉或指侧静脉。我们自1992年1月至1993年5月,应用吻合指掌侧静脉和指侧静脉替代有缺损或无指背静脉的方法,行断指再植10例13指全部成活,报告如下。1 临床资料 本组10例均为男性,年龄16～33岁,均为完全性离断。电锯伤4例,冲床挤压伤3例,绞肉机绞伤1例,传送带绞伤1例,刀伤1例;食指6个,中指3个,环指2个,小指4个。断离平面:近节2个,近节指间关节水平     

以掌背动脉远端皮支为蒂的逆行皮瓣修复手指创面

目的 探讨应用以掌背动脉远端皮支为蒂皮瓣修复手指中远端软组织缺损.方法 第2、3、4掌背动脉远端皮支皮瓣和皮神经显微缝合修复手指中远节软组织缺损伴指骨、肌腱外露共9例.其中,拇指2例,食指3例,中指3例,小指1例.创面面积:6.0cm×2.0cm～2.5cm×1.5cm.皮瓣大小:8.5 cm×3.5cm～3.0cm×2.5cm,蒂长2.5 cm～4.0cm.结果 皮瓣成活,创面Ⅰ期愈合.术后随访6个月,皮瓣两点分辨觉7～9mm,指关节活动满意,供瓣区无伸肌腱黏连.结论 掌背动脉远端皮支皮瓣和皮神经显微缝合是修复手指中远节软组织缺损恢复感觉的可靠方法.     

复杂性断指再植52指

1986～1995年，我科收治复杂性断指52指，均为完全性断指，再植成功47指，成功率达90．4％，报道如下。工临床资料1．l一般情况本组52指，男35指，女17指，平均年龄27岁。甲根部离断或术节离断静脉损伤11指；指动脉缺损，近端动脉抽脱缺损13指；断指指背皮肤缺损或指背静脉损伤10指；指动脉缺损并皮肤缺损18指。1．2治疗方法（1）甲根部离断或本节离断静脉损伤采取动、静脉转流法，将远端的～例动脉与近端静脉吻合；（2）指动脉缺损，近端动脉抽脱缺损采取静脉移植或邻指动脉转位修复；（3）断指指背皮肤缺损或指背静脉损伤，采取邻指背侧皮…     

近指节残端掌指关节复合移植再造手指

1983年9月以来,对多指近节外伤性缺损的6例患者,用其中一个残端及其掌指关节复合移植至另一残端的新方法再造手指获得成功。术中吻合一条指总动脉、指背静脉及两条指神经。再造指长度为4.5～7.0cm,指间关节血循及感觉良好。经1～2年随访,再造指可较满意地完成手指的各项主要功能。该方法供移植组织取自残手,不牺牲其他正常组织,方法比较简便,较易为患者所接受。     

中指拇化及大鱼际逆行皮瓣在手部爆炸伤中的应用

目的探讨手部爆炸毁灭性损伤(又称毁损伤)的手术修复方法。方法 2007年1月～2011年10月,收治成年手部爆炸毁损伤患者19例,主要表现为拇、食、中指均受损,全部实行中指拇化联合二期大鱼际逆行皮瓣转移术治疗,连续观察近、远期疗效。结果所有手术均顺利完成,11例患者一期中指拇化后伤口愈合,余8例出现不同程度骨外露,经二期行大鱼际逆行皮瓣转移术治愈;随访3～36个月,骨骼愈合良好,移化中指外形美观,血运及感觉良好,两点分辨率(2.5 mm～3.5 mm)与健侧(2.0 mm～3.5 mm)接近,但为异位感觉,移位中指功能TAM评定,优13例,良6例。结论采用中指拇化及大鱼际逆行皮瓣转移术治疗手部爆炸毁损伤安全、可靠、有效。     

Reconstruction of the thumb using a forearm osseofasciocutaneous reverse flap

This paper presents the experiences of the thumb reconstruction with osteofasciocutaneous reverse flap (OFCR flap). In the period between 1987 and 2000 the OFCR flap was used in 15 patients. The youngest of them was 18 and the oldest was 38 years of age. The average age was 25.4. All the patients had posttraumatic amputations. Defects on proximal phalangae and a part of metacarpal bone occurred in two cases. In one case there was an amputation on the base level of proximal phalanx and the metacarpophalangeal (MPH) joint was preserved. In all cases of reconstruction the OFCR flap was used, which included antebrachial skin nervs that were anastomosed with digital nerv. The flap nutrition was carried out through the reverse circulation of a. radialis, and the venous drainage through the comitant vein of a. radialis. Superficial veins were not anastomosed. Secondary defects were covered with a free skin graft. All the flaps survived. The bone graft was healed in the period of eight weeks. The sensibility of this flap was regained in the period of three to six months after the surgery. The distance of two-point discrimination (TPD) was increased for 30% compared to the same region on the other hand after six months. The opposition of the reconstructed thumb to the other fingers was possible, as well as abduction, adduction and normal grasp. The method of reconstruction of the amputated thumb with the OFCR flap was better than other classical methods because it allowed the reconstruction of all the structures in one surgical operation. The sensibility that was regained represented good protection from injuries. There were no functional damages on the secondary defect. The esthetic result was not good due to the lack of a fingernail.     

Superior pinch strength in the dominant versus nondominant hand

We evaluated the differences in pinch strength between the thumb and each of the fingers in the dominant and nondominant hands. The subjects were 30 healthy young adult males (mean age 18.5 ± 2.6 years, mean height 174.2 ± 6.5 cm, mean weight 68.0 ± 7.9 kg) with right hand dominance. For each subject, the pinch strength between two fingers (the thumb and each of the other fingers) in the dominant and nondominant hands was measured. Significant differences between pinch strength in the dominant and nondominant hands were found for the thumb–index finger and thumb–middle finger, with the dominant hand having 18 % greater strength. The pinch strength between the thumb and each of the other fingers was ranked in the order of index finger, middle finger, ring finger, and little finger. All correlations were significant, but values for the middle and ring fingers (r = 0.95 and 0.89) were significantly larger. In conclusion, the pinch strength of the fingers most frequently used in daily life is markedly different between the dominant and nondominant hands, but their relationship is low.     

小儿多指并指畸形的显微重建

目的：探讨小儿多指并指畸形的显微重建方法。方法：自2008-08-2013-08对78例年龄在1-7岁的小儿拇、手指多指、并指畸形进行显微重建手术治疗。结果：2例复杂性复拇畸形患儿,术后因一侧关节囊松驰,两侧韧带失去平衡,指间关节偏斜,1例因骺软骨切除不彻底,致拇指掌指关节畸形发育,2例并指指蹼成形术后指蹼变浅,分指受限,经二次矫正后外形恢复,关节恢复平衡,其余术后均使畸形得到矫正,外形美观,功能恢复满意。结论：小儿多指并指畸形的显微重建术有很高的临床实用价值。     

四肢离断再植29例临床分析

目的探讨创伤后上下肢离断29例再植手术的临床疗效及治疗体会。方法选取2004年1月~2014年11月收治的29例四肢离断伤患者,男性23例,女性6例;年龄23~47岁,平均35岁。其中电锯伤9例,砍伤6例,旋转撕脱伤3例,挤压碾轧伤11例;离断平面:上肢损伤9例,包括手掌部离断1例,前臂离断5例,上臂离断3例;下肢损伤19例,包括足部离断3例,踝部离断8例,小腿离断7例,双踝部完全离断1例。结果 29例共离断30肢,其中5例术后因血管危象行血管探查修复,2例发生感染导致再植肢体坏死,进而截肢;9例术后一次性成功;18例术后伤口部分皮肤坏死,行创面换药及二次植皮手术伤口愈合,成活率93.1%。按照断肢再植术后功能评定标准:上肢:Ⅰ级3例,Ⅱ级4例,Ⅲ级1例,1例再植失败;下肢:Ⅰ级9例,Ⅱ级9例,Ⅲ级1例,1例再植失败。结论综合考虑患者的全身情况,选择再植的适应证,合理全面的清创固定,及时正确的修复血管、神经、肌肉、肌腱等组织,术后合理的康复锻炼及功能锻炼,是提高断肢再植成活率及功能康复的重要因素。     

多指离断再植的体会

目的总结手部多指完全离断再植成功经验。方法 2013年6月—2016年3月西南医科大学附属中医医院手外科成功再植多指离断30例,男性17例,女性13例;年龄2~63岁,平均32.5岁。单手多指离断26例,其中2指离断10例,3指离断9例,4指离断5例,5指离断2例。双手各1指离断2例,各3指离断2例。应用显微技术,按照先清创-骨折复位内固定(克氏针贯穿或交叉内固定)-修复指伸肌腱-修复指屈肌腱-吻合指固有动脉及指固有神经-吻合指腹部静脉-吻合指背部静脉-缝合皮肤关闭创面的顺序完成所有断指的再植。术后进行科学康复训练并坚持随访3~18个月,结合文献分析多指离断再植成活和功能恢复的经验。结果本组30例患者均获随访,术后3个月回访,再植手指愈合良好,外形美观;术后12个月回访,再植手指皮肤感觉恢复正常,再植手指握、捏及对掌功能部分恢复。末次回访时,参照中华医学会手外科学分会断指再植功能评定试用标准评价疗效,本组(85.3±2.5)分,优21例、良6例、差3例。除坏死3指外,均未出现指体创面感染、骨折不愈合等并发症。术后发生动脉危像3指,经手术探查后解除。并发肌腱粘连5指,术后6个月后行肌腱松解术后手指屈伸功能恢复。结论多指离断再植成功不仅需要周密的计划安排和团队的合作,而且关键在于高超的血管吻合技术。     

The thumb during the crimp grip

During rock-climbing, fingers grasp holds of various shapes with high force intensities. To ideally place the fingertips on the holds, the thumb is sometimes positioned on the nail of the index finger. This allows using the thumb as an additional actuator by exerting a supplementary force in the same direction as the index, middle, ring and little fingers. This study analysed how the forces exerted by the fingers are modified by the additional action of the thumb. The results showed that the thumb increases the resultant forces exerted on the hold. It was shown that the pathology risks of the middle, ring and little fingers were not modified in this condition. The finger force sharing was totally re-organized due to the support of the thumb. This led to the conclusion that the central nervous system organised the association of the 5 fingers. The results were discussed in regard to the established theories of the virtual fingers and the neutral line of the hand.     

Cuts to the offender’s own hand—unintentional self-infliction in the course of knife attacks

In a knife attack the perpetrator can unintentionally injure his own hand, if the knife does not have an adequate handguard and the tip of the blade hits a solid, mostly bony structure while being violently thrust into the victims body. The injuries occurring under these conditions are localized on the flexor side of the knife-holding hand and may include the index, middle, ring and little fingers. They are seen particularly often on the little finger at the level of the proximal phalanx and in the skin fold of the proximal interphalangeal joint. The majority of these cuts run transversely to the longitudinal axis of the fingers and can show a step-like arrangement with different distances to the metacarpophalangeal joints, often from ulnar-proximal to radial-distal. In the six cases presented the injuries were most pronounced on the ulnar side of the hand. When the flexor tendons of the fingers are also severed and the tendon stumps are strongly retracted this indicates that the fist was firmly closed at the time of the injury.Dedicated to Prof. Dr. Dr. h. c. B. Brinkmann on the occasion of his 65th birthday.