指尖离断伤原位缝合术后即刻高压氧辅助治疗

目的 探讨指尖离断伤原位缝合术后即刻高压氧辅助治疗的疗效.方法 将2005年8月-2009年6月收治的25例（28指）指尖离断伤患者,根据离断平面不同分为Ⅲ型,采用原位缝合术,术后即刻辅助高压氧治疗.结果 28指中25指成活,成活率89.3%.术后平均随访21.2个月,手指外形与健侧相近,痛、温、触觉均存在.结论 该方法可提高指尖离断采用原位缝合的成活率及成活质量.     

指尖离断原位缝合的体会

对于指尖离断伤的治疗方式多种多样,各有利弊,各种方式对设施条件和技术水平的要求相距较大。本人于1995年3月至2001年12月,对指尖离断伤采用原位缝合的方法,取得了满意的效果,非常适合在基层医院中推广运用。1资料与方法1.1一般资料:本组共15例18指。其中男9例,女6例;年龄17～56岁,平均年龄30.7岁。食指9指,中指6指,环指3指;单指损伤12例,二指损伤3例。离断平面,根据田万成、范启申[1]手指尖分型:本组病例中Ⅱ型11指,Ⅲ型5指,Ⅳ型2指,没有选择Ⅰ型、Ⅴ型的病例。损伤原因,切割伤9指,碾压伤9指。18指均完全离断,游离端均挫伤不十分严重,创面…     

扩大骨髓腔在指尖离断原位缝合术中的应用

目的评价扩大骨髓腔在指尖离断原位缝合中的应用及临床疗效。方法对27例无再植条件的指尖离断伤应用扩大骨髓腔的原位缝合术，术中纵向扩大残指指骨骨髓腔后，固定指骨骨折，并沿手指纵轴向近端加压固定。结果本组共27例，术后随访6～12个月，完全成活19例，犬部分成活2例，坏死6例，成活指尖外观和功能恢复良好。结论对于无再植条件的指尖离断伤，行扩大骨髓腔的指尖离断原位缝合术，是一种有效简便的方法。     

原位缝合治疗指尖离断的疗效观察

目的观察原位缝合治疗指尖离断的疗效并探讨其可行性和优点。方法2004年3月-2010年9月,对45例45指无可供吻合血管的指尖离断行原位缝合手术,术中行断指修整短缩,扩髓后固定骨折,间断缝合创缘,术后予三抗、高压氧治疗,指端做小切口放血引流。结果34例断指成活,占75．5％,3例部分坏死,占6．7％,8例坏死,占17．8％;成活指中25例指腹饱满,9例指腹萎缩、变细。结论对无可供吻合血管的断指,原位缝合是一种积极、简便、有效的治疗方法。     

儿童指尖离断的修复

指尖很容易受到损伤，儿童正处于生长发育期，缺损后对手的功能和外观均产生严重影响，同时对儿童心理造成一定创伤，因此儿童指尖离断，必须尽可能修复。我院于1995～2001年采用吻合血管的指尖再植和原位缝合术，再植23例儿童指尖离断患者，取得良好效果，现报道如下。１资料与方法１．１临床资料本组23例，男16例，女7例；年龄5～13岁。切割伤14例，挤压伤8例，电锯伤1例。拇指2例，示指9例，中指6例，环指5例，小指1例，均为完全离断。离断平面：甲根部15例，半月线部6例，指甲中段以远2例。１．２手术方法1.2.1指尖再植于显微镜下清创，…     

食指末节完全离断原位缝合成活1例

患者男,17岁,因右食指被机器压断后3h入院。专科所见：右食指甲根部以远指体完全离断,创面呈斜形。创缘不齐,皮肤挫伤较重,创面内可见神经、血管抽出约0．3cm。离断指体完整。入院诊断：右食指末节完全离断。急诊在指根麻醉下拟行右食指原位缝合术,术中将创面内组织修剪整齐,咬骨钳将骨折端碎骨咬除并挫平,克氏针将近端骨折端钻3个小孔。     

改良的原位缝合方法行指尖离断再植

指尖离断较为常见，在无条件再植的病例，多采用短缩缝合或皮瓣修复，皮瓣修复外形不理想；而原位缝合，成活率较低。针对该类损伤，我们于2001年8月～2004年5月，设计了改良的原位缝合方法，不仅尽可能保留了手指外观及长度，而且取得了较高成活率，现报道如下。     

原位回植加压包扎治疗37例指尖离断伤

目的探讨指尖离断伤治疗方法和疗效。方法手术治疗指尖平面完全离断伴有指骨、甲床损伤而无法再植的37例患者(39指),创面面积:0.3 cm×1.2 cm~0.5 cm×1.8 cm。常规清创后,将离体指与近端断面解剖复位,用5-0丝线间断缝合,加压包扎固定;术后12 d拆除加压包堆,3周拆线。结果成活34指,成活率87.2%。33例获得随访,时间3~24个月,伤指外形、颜色与健侧基本无异,指甲生长完好,局部无触、压痛,痛温觉及精细感觉基本恢复正常。结论应用原位缝合打包加压包扎修复指尖离断无法再植的手指,可以保留最佳的外观和功能。     

指端甲半月以近离断原位缝合成活1例

1病例资料患者:男性,28岁,因右手中指刀砍伤后1小时,于2007年2月8日入院,手外科检查:右手中指末节自远侧指间关节以远甲根部甲半月切迹以近横行离断,创缘规整,远端无挤压及捻挫。入院诊断:右手中指末节完全离断。急诊在局麻下行离断指端原位缝合术,术中彻底清创,清除近远端创面     

去甲原位缝合治疗指端离断伤

1988年～1992年,我们对较整齐的指端离断伤进行去甲原位缝合,甲床局部滴注肝素,取得满意疗效。报道如下。 本组18例20指,男10例11指,女8例9指。年龄5～35岁。拇指6个,食指9个,中指2个,环指3个。致伤原因皆为切割伤。断面:在甲缘至甲根月状迹远侧缘之间者8例9指,在月状迹之间者7例8     

An innovative removable rigid dressing technique for below-the-knee amputation.

The below-the-knee removable rigid dressing is a below-the-knee plaster cast held by a suspension stockinette to a supracondylar plastic cuff. It has proved to be an effective method for postoperative, pre-prosthetic, and prosthetic care of below-the-knee amputees. Being removable, it permits frequent observation and progressive shrinkage of the stump (by adding socks), and eliminates the need of elastic stump bandaging. In addition, it still maintains the advantages of immobilization of soft tissue (to reduce pain and facilitate wound healing) and prevention of trauma to the stump as does the conventional rigid dressing. It has significantly reduced the incidence of pre-tibial skin breakdown and distal edema, produced fast stump shrinkage, and shortened time to ambulatory discharge with a temporary prosthesis by ninety days.     

A systematic review of outcomes of revision amputation treatment for fingertip amputations

Purpose

The purpose of this study was to conduct a systematic review of outcomes of fingertip revision amputation for fingertip amputation injuries in the English-language literature to provide best evidence of functional outcomes.

Methods

A MEDLINE literature search was performed to identify studies that met the following criteria: (1) reported primary data; (2) included at least five cases of primary revision amputation treatment following digit amputation injury; (3) reported finger or thumb amputation at or distal to the distal interphalangeal (DIP) joint or interphalangeal (IP) joint, respectively; (4) presented at least one of the following outcomes: static two-point discrimination (2PD), cold intolerance, arc of motion (AOM) of metacarpophalangeal (MCP) joints, proximal interphalangeal joints (PIP), DIP joints, or return-to-work time.

Results

Thirty-eight studies met the inclusion criteria. Twenty-seven studies reported 2PD, 20 studies reported cold intolerance, eight studies reported AOM, and 18 studies reported return-to-work time after revision amputation of fingertip injuries. The mean 2PD was 5.6 mm. On average, 24 % of patients experienced cold intolerance. AOM at the PIP joint was reported in four studies and averaged 94°. DIP joint AOM was presented in four studies and averaged 66°. Thumb MCP and IP joint AOM was presented in three and four studies, respectively. Mean thumb MCP joint AOM was 54° and that of the IP joint was 71°. The mean return-to-work time was 47 days.

Conclusions

On average, fingertip revision amputation can achieve almost normal sensibility and satisfactory motion and patients can expect to return to work on average approximately 7 weeks after surgery.     

Management of partial fingertip amputation in adults: Operative and non operative treatment

BackgroundHand and finger injuries account for approximately 4.8 million visits to emergency departments each year. These injuries can cause a great deal of distress for both patients and providers and are often initially encountered in urgent care clinics, community hospitals, and level one trauma centers. Tip amputation injuries vary widely in mechanism, ranging from sharp lacerations to crush injuries that present with varying degrees of contamination. The severity of damage to soft tissue, bone, arteries and nerves is dependent upon the mechanism and guides treatment decision-making. The management algorithm can oftentimes be complex, as a wide variety of providers, including orthopedists, general surgeons, plastic surgeons and emergency physicians, may care for these injuries, depending on location and local culture. We review the common mechanisms for tip amputation and the optimal treatment in adults, based on the severity of the injury, degree of wound contamination, and the facilities available to the provider.MethodsPubmed was searched using text words for articles related to management of fingertip injuries in adults. Bibliographies of matching articles were searched for additional relevant articles, which were then also reviewed. 107 articles were reviewed in total, and 61 were deemed relevant for inclusion. All clinical studies and reviews were included. Particular attention was paid to articles published within the past 15 years.ResultsIn the United States, up to 90% of fingertip amputations are treated with non-replant techniques. In comparison, the majority of amputations in Asian countries are replanted due to moral values and importance of body integrity. Tip amputation injuries can be managed with local debridement, complex reconstruction, or simply with irrigation and application of a sterile dressing.ConclusionIn the United States, most fingertip amputations in adults are treated with non-replant techniques. However, the precise management of a fingertip injury in adults depends on the degree of injury itself, and a number of operative and non-operative techniques may be successfully employed.     

Purse-string suture as a complementary technique with conventional flaps in repairing fingertip amputation

The main aim of the treatment in fingertip amputations is to establish the functional and aesthetic construction of the fingertip. The aim of this study is to discuss how to use purse-string suture as a complementary technique accompanying conventional flaps repair in fingertip amputation. Fifty-four patients with fingertip amputations on the nail bed referred to our center for fingertip reconstruction. From which 41 patients who had at least one-third of their nail remained (to preserve the nail) were chosen to undergo this new technique. Patient's satisfaction of the achieved functional results (in case of pain and motion) was as follows: 32 responded excellent, 8 good, and 1 fair. Also, patient's satisfaction of the achieved aesthetic results were Excellent = 7 and Good = 2 in females (n = 9) and Excellent = 19, Good = 7 and Fair = 6 in males (n = 32). 93% (38 patients) of the patients had two-point discriminationof less than 3 mm. No flap necrosis was observed in this study. The flap donor site was covered by primary closure (in 24 cases), secondary intention (in 11 cases), and skin graft (in 6 cases). The nail and finger contour are important for achieving a satisfying aesthetic and functional result. We believe that this new complementary technique could be an easy way for reaching this end. It is recommended that this technique be applied to all fingertip injuries to preserve the nail.     

Extending the limits of fingertip composite grafting with moist-exposed dressing

We introduced the concept of moist wound healing to extend the limits of fingertip composite grafting. In this retrospective study, we assessed the success of fingertip composite grafting with moist-exposed ointment dressing, which has been shown to maintain adequate moisture for optimal healing by frequent ointment application without the need for a secondary overlying dressing. We reviewed the outcome of composite graft replacement of 60 amputated fingertips in 56 consecutive patients over a period of 3 years and 3 months. Forty-two fingertips had survived completely and 18 had failed. Twelve of 15 fingers among patients younger than 15 years of age and 30 of 45 fingers among those 16 years of age and older had survived completely. We believe that our use of antibiotic ointment to maintain a moist environment was an important factor in improving the survival of composite grafts.     

Nail recession emergency treatment: a new technique for the repair of fingertip amputations

INTRODUCTION: In spite of the recent advances made in microsurgery, the reconstruction of oblique fingertip amputations remains problematical. In cases where reimplantation is technically impossible, the surgeon can utilize a number of different flaps to preserve digital length. METHODS: In certain cases, instead of local flap repair using an advancement flap, the nail complex can be recessed so that after bone shortening of the distal phalanx the free edge of the nail can be stitched to the skin without resulting tension. Two longitudinal incisions are made, and a flap including the nail complex is obtained from the distal phalanx. The dissection is made as far as the base of the middle phalanx, and is superficial so that it does not affect the distal branches of the middle phalangeal arteries. This technique was used consecutively in three cases of oblique fingertip amputations. RESULTS: The average shortening required was 10 mm. In all three cases, the nail was preserved, and pulp sensitivity was excellent (mean static two-point discrimination of 5 mm, Semmes-Weinstein monofilaments of 2.83-3.61). The mean period before return to work was 5 weeks. No proximal interphalangeal joint stiffness was noted. However, all the patients complained of pain upon exposure to cold. DISCUSSION: This technique is simple to use, and combines the advantages of bone shortening with the esthetic aspect of preserving the nail complex. No palmar dissection is necessary, and the standard risks associated with advancement flap techniques are thus avoided. Although this reconstruction method results in a shorter finger, good functioning and good immediate sensitivity are maintained.     

Use of Doppler pressure measurements in predicting success in amputation of the leg

Fifty-five patients underwent amputation of the leg. Fifty-eight percent of the amputations were above-knee and 32 percent below-knee. Preoperative Doppler ankle blood pressure measurements and $\text{ankle}\text{brachial}$ ratios were compared and correlated with wound healing in patients with below-knee amputation. Statistical analysis documented that such measurements were significant in predicting wound healing. If blood pressure greater than 55 mm Hg at the knee, greater than 70 mm Hg at the incision site or greater than 70 mm Hg at the ankle or an $\text{ankle}\text{brachial}$ ratio of at least 0.3 is documented, satisfactory healing will follow amputation.     

缺乏可供吻合静脉的指尖离断再植方法选择

目的:探讨缺乏可供吻合静脉的指尖离断再植方法。方法:自2004年11月至2009年11月,对86例104指指尖离断患者进行再植,其中男64例,女22例;年龄2～64岁,平均26岁。伤后至就诊时间30min～12h,断指缺血时间2.5～12h,术前各项检查均未见明显异常。采用4种再植方法:①吻合双侧指固有动脉,指根部结扎一侧指固有动脉的断指再植,37指;②动-静脉转流方式的断指再植,27指;③只吻合指动脉的断指再植,24指;④去表皮囊袋法再植,16指。结果:86例104指,成活102指,伤指成活病例中75例(92指)获得随防,时间6～24个月。按中华医学会手外科学会断指再植术后功能评定试用标准评定:优52例,良19例,差4例。结论:依据显微镜下清创所见离断指尖动脉损伤状况,选用不同的再植方式,有助于扩大指尖再植适应证,提高再植成功率。     

Homodigital antegrade-flow neurovascular pedicle flaps for sensate reconstruction of fingertip amputation injuries

Fingertip amputations through the distal 50% of the nail matrix usually create a finger that is best served by maintaining length. When the amputation is more proximal than this, revision with ablation of the small residual nail unit may provide greater overall patient satisfaction. When amputations in the distal 50% of the nail matrix are transverse or short oblique in orientation, a flap of some kind is needed to restore the contact surface of the pulp. Many alternative reconstructive strategies are possible but have inherent limitations that detract from the quality of the final result. Inadequate padding, lack of sensibility, excessive tension, hook nail deformity, poor durability, and donor site morbidity are but some of the considerations. Although not a panacea for all distal fingertip amputations, the antegrade-flow homodigital neurovascular pedicle flap offers a good ratio of advantages to disadvantages. As with all flaps, knowledge and execution of the details largely determine the outcome.