Replantation of amputated facial tissues with microvascular anastomosis

A challenge to the microsurgeon is perfecting the technique of replantation of small pieces of facial tissue, mainly because of the extremely small size of the arteries as well as a lack of suitable veins for drainage. In the past 4 years, we have had seven cases of facial amputations, which included one scalp, two nasal tips, two ears, one lower lip, and one eyebrow. All of these patients were replanted/revascularized by microvascular anastomosis. Only two of the cases had suitable veins for anastomosis. Alternative techniques used for improving venous outflow were arterio-venous fistula, chemical leeches, and pin pricks. Four of the cases were completely successful, two cases had partial loss of the replant, and one case failed due to absence of venous drainage. In facial amputation, an aggressive microsurgical attempt will result in more tissue surviving and a better cosmetic outcome than in any other reconstructive procedures. © 1994 Wiley-Liss, Inc.     

手指侧方组织块完全离断再植的临床体会

目的:探讨对手指侧方组织块完全离断行再植手术的必要性及方法。方法 :2012年3月至2015年4月,对62例各种原因导致手指组织块完全离断患者的治疗进行回顾性分析,其中男34例,女28例;年龄17~52岁,平均29.1岁。其中拇指27例,示指15例,中指13例,环指8例,小指2例,其中2指合并受伤3例,14例累及远侧指间关节;受伤至治疗时间30 min~2 h,平均1 h。全部采用急诊行再植术。术后随访观察手指外观、指端感觉及患指功能恢复情况。结果:62例完成手术者中58例成活,成活指随访3~15个月,平均6.5个月,按照中华医学会手外科学会上肢部分断指再植功能评定试用标准评定疗效,优52例,良3例,可3例,优良率94.8%。结论:对于手指侧方组织块离断再植存活后外观和功能良好,只要患者全身情况允许,远离断的指体尚完整,有可供吻合的血管和神经,都应力争对其进行再植。     

断指再植的发展与提高

1963年，我国陈中伟、钱允庆等成功地为1例右腕上完全离断的断手进行了再植，功能恢复良好，该病例于同年9月在罗马举行的第20届国际外科学术会议报告，被一致公认为世界上断肢再植成功的首例报道。由此，使人们认识到，人体的部分组织或器官离体后立即予以再植，可回归人体，并恢复一定功能。这一     

手指小组织块离断再植的临床体会

目的 探讨手指小组织块离断后再植的手术方法和治疗效果.方法 对手指不同部位小组织块离断20例26指,采用血管直接吻合、桥接吻合、动脉静脉化、静脉动脉化等多种血运重建方式进行原位再植.结果 再植组织块完全成活25指,部分坏死1指,经过换药后痊愈.术后随访6～12个月,再植指屈伸功能良好,外形满意.结论 对手指不同部位小组织块离断,采用显微外科重建技术原位再植,能获得较好的临床疗效.

Abstract：

Objective To investigate the replantation methods and outcomes of mini tissue mass of amputated finger. Methods Twenty-six fingers of 20 patients were replanted with multiple vessel anastomosis methods to restore blood supply.The methods include vascular anastomosis,vascular bridge,arteriovenolization,veno-arteriolization,et al. Results Twenty-five replanted tissues were survived completely.Partly necrosis occur in 1 case,and rehabilitation by change dressings.The patients were follow up from 6 to 12 months.The contour and function of the replantation fingers recovered satisfactory. Conclusion By using the rational anastomosis according to the traumatic condition,it could be obtain good outcome of mini tissue mass replantation     

手指小组织块离断再植的临床体会

目的 探讨手指小组织块离断后再植的手术方法和治疗效果.方法 对手指不同部位小组织块离断20例26指,采用血管直接吻合、桥接吻合、动脉静脉化、静脉动脉化等多种血运重建方式进行原位再植.结果 再植组织块完全成活25指,部分坏死1指,经过换药后痊愈.术后随访6～12个月,再植指屈伸功能良好,外形满意.结论 对手指不同部位小组织块离断,采用显微外科重建技术原位再植,能获得较好的临床疗效.     

手指小组织块离断再植的临床体会

目的 探讨手指小组织块离断后再植的手术方法和治疗效果.方法 对手指不同部位小组织块离断20例26指,采用血管直接吻合、桥接吻合、动脉静脉化、静脉动脉化等多种血运重建方式进行原位再植.结果 再植组织块完全成活25指,部分坏死1指,经过换药后痊愈.术后随访6～12个月,再植指屈伸功能良好,外形满意.结论 对手指不同部位小组织块离断,采用显微外科重建技术原位再植,能获得较好的临床疗效.     

断指再植31例38指

手指离断伤是手部较常见创伤之一,作者自2002年6月至2005年5月对31例38指离断手指进行再植术,取得较满意效果,现报告如下。1临床资料本组31例38指,男22例,女9例;年龄17～60岁,平均31岁。损伤原因:电锯锯伤或切割机伤17例,机器撕脱伤或冲压伤5例,钢丝绞伤3例,刀砍伤5例,骑车撞伤     

Replantation of totally amputated ears

From a total of 1525 replantations or revascularizations performed at our clinic we report three replantations of totally amputated ears. In two the cause of amputation was a car accident and in the third case a dog bite. In the first case no suitable artery for anastomosis was found on the amputated part and the replantation was performed by means of arterialization of the venous system [3, 8, 12]. After 2 days the mild venous stasis subsided, and a normal blood supply to the ear was established. In the two other cases both arteries and veins were sutured without any complications. All three cases healed successfully and completely.     

拇指指尖离断再植

目的 介绍拇指指尖离断再植的临床经验。方法 采用改良逆行再植方法，用三种血运重建的方式对105例拇指指尖离断进行再植。结果 再植105例，成活四例，成活率94.2％，术后手指外形和长度与健指相似，两点辨别觉3～6mm，指甲生长良好。结论 熟悉拇指指尖血管分布规律及再植特点，可以明显缩短再植时间，提高再植成功率。     

手指套脱性断指再植

目的探讨手指套脱性离断伤再植方法的可行性。方法对10例18指手指套脱性离断伤的患者，进行再植术。结果再植18指，术后成活16指，坏死2指，成活率为89％。术后随访5～12个月，手功能和外形满意，再植指两点分辨觉为4～9min，按中华医学会手外科学会上肢部分功能评定试用标准评定：优14指，良2指，优良率达100％。结论手指套脱性离断伤，只要套脱皮肤完整，可以通过再植的方法恢复手部的功能和外形。     

Replantation of completely amputated thumbs with venous arterialization

PURPOSE: To report a new method of replanting completely amputated thumbs with venous arterialization. METHODS: In 6 replantation surgeries of completely amputated thumbs performed during the period 1999-2003, the proximal artery was anastomosed with a vein of the amputated part to establish inflow and the proximal vein was anastomosed with several other veins in the amputated part to establish outflow. This was because the proper palmar digital arteries were seriously injured or anastomosis of proper palmar digital arteries failed many times. RESULTS: All the replanted thumbs survived, regained good sensory and motor functions, and showed no difference from thumbs replanted conventionally. CONCLUSIONS: Venous arterialization may salvage otherwise unreplantable thumbs.     

指尖离断分型与再植

目的 报告指尖离断分型与再植效果。方法 依据指尖显微解剖和临床应用分为Ⅵ种类型。Ⅰ型——甲弧至半月线处离断;Ⅱ型——甲中段以远离断;Ⅲ型——甲区各种斜形离断;Ⅳ型——指腹撕脱离断;Ⅴ型——指尖脱套性离断;Ⅵ型——指尖与手指近端同时离断(一指两段)。结果 临床共再植278例312指,成功率95.2％。结论 指尖离断分型能指导医生进行再植手术。     

特殊类型的断指再植

目的 报道特殊类型断指再植的方法及临床疗效。方法 对末节断指，1指多节离断断指，小儿断指，拇指撕脱性离断断指，双手多指离断断指及手指脱套性断指，根据不同的伤情采用不同的方法再植。结果 1532例上述断指再植存活1475例，存活率96．27％。外形及功能均较满意。结论 特殊类型手指离断伤，应严格掌握适应证，采用不同的方法施行再植，可获得较高的存活率，并能恢复较好的外形与功能。     

Replantation of completely amputated distal forearm--1965

Although replantation of completely amputated wrists and forearms is now commonplace, in 1965 the replantation of this "wrist level" amputation was the first reported in the western world. The details of the technique used are contrasted with current standard of care.     

Replantation of an amputated upper lip.

Soft tissue defects of the face are a difficult reconstructive problem. Replantation of large amputated segments of the face has been rarely successful and has lagged well behind extremity trauma due in part to the relative rarity of these defects. Presented is a case of successful microvascular replantation of half of the upper lip after a dog bite.     

Replantation of an amputated nasal tip with open venous drainage

Replantation of small parts often results in failure. The impractical size and the frequent absence of veins suitable for anastomosis, together with venous congestion and thrombosis, are the main problems. A case is described of an amputated nasal tip and successful replantation by means of microsurgical arterial repair and open venous drainage due to absence of suitable veins in the specimen. In cases in which there is no possibility of repairing the venous system, open venous drainage may be an easy and feasible method to prevent venous congestion and replant failure. © 1993 Wiley-Liss Inc.