External Venous Drainage: Solution to a Pediatric Artery-Only Fingertip Replantation-A Case Report and Literature Review

外在靜脈引流系統－兒童遠端指節唯指動脈接合之斷指重接的解決方式－病例報告及文獻研討

李璧蓉(Pi-Jung Lee)

《臺灣整形外科醫學會雜誌》 24卷4期 (2015/12) Pp. 372-381

摘要

背景：遠端指尖截斷再接可以有相當好的功能及外觀的回復，但因為其極微小的血管尺寸，以及有時無法達成的靜脈修補，導致有其手術的困難度。而影響此類斷指失敗的最大主因常為靜脈充血。目的及目標：本文主要探討在無法完成靜脈修補的斷指再接上，使用外在靜脈引流方式而可以達到循環，並做相關文獻回顧以了解外在靜脈引流系統所需時間以及預防血管痙攣。材料及方法：一位７歲的男孩，右手壓砸傷導致食指末段指節截斷，斷指重接手術只能接合指動脈，靜脈引流的部分則使用外滴肝素溶液於甲床上使其持續性微量出血。為避免溶液滴注造成指溫下降而血管痙攣，外滴肝素溶液使用加熱器加溫後使用。結果：病人術後手指循環溫暖良好，骨頭癒合及神經感覺也如期恢復。結論：即便是目前進步的顯微手術技術及器械下，極遠端指節斷指仍存在其靜脈修補的困難度。如何締造一個完整可信的靜脈引流系統，是影響斷指重接手術的成功率的關鍵。

並列摘要

Background: Distal fingertip replantation always presents good functional and aesthetic outcome although technical challenges, such as extremely small digital vessels and unavailability of repairable veins, frequently await hand surgeons during the operation. Venous congestion is one of the common reasons for replantation failure. Aim and Objectives: In this report we emphasize the role of external venous drainage in cases for which venous repair is not feasible. Moreover, discussions were made to determine the appropriate duration of external drainage and methods to avoid vasospasm. Material and Methods: A 7-year-old boy suffered a traumatic digit amputation following of a crushavulsion type injury to his index finger. The amputation level was classified as Tamai zone 1. Replantation was carried out with artery-only repair. Post-operative artificial venous drainage was created by needle pricking and heparin solution soaking. To reduce vasospasm induced by cold fluid soaking, the heparin solution was heated before use. Results: The replanted digit obtained adequate perfusion and survived well. Bone healing and sensation recovery are on schedule. Conclusion: Distal fingertip amputation remains a challenge to hand surgeons up to date, despite the improvement in surgical technique and instruments. Venous repair is usually not feasible for such cases. Therefore, adequate venous drainage via alternative methods is essential for replantation success.

並列關鍵字

fingertip replantation ； pediatric replantation ； chemical leech ； artery-only anastomosis