Reconstruction of the Non-Replantable Digital Amputation

不可再植之斷指重建

顏元豪(Yuan-Hao Yen) ； Carolina Carvajal Forero ； Rowena Sudario-Lumague ； 林燦勳(Tsan-Shiun Lin)

《臺灣整形外科醫學會雜誌》 29卷1期 (2020/03) Pp. 12-23

摘要

Background: Non-replantable traumatic digital amputation requires different management approach depending on the level and severity. Several surgical techniques including local, distant and free flap transfer, have been described in the literatures. These reconstructions result in good functional outcomes but often accompany with bulky digits with poor cosmetic appearance, compared with the non-injured digits. Aim and Objectives: This paper describe our experience using non-sensate distant pedicled flap and one-stage secondary debulking procedure to salvage non-replantable digital amputation. Materials and Methods: From 2010 to 2017, there were 15 cases with 26 non-replantable digital amputation, including patients who suffered from amputation of fingers with crushed or degloved amputees. 12 cases were reconstructed with pedicled groin flaps, 3 cases with abdominal random flaps, 1 case with pedicled anterolateral thigh (ALT) fasciocutaneous flap combined with groin flap. They all underwent one-stage secondary debulky procedure for the bulky flap and interdigitalization. Results: The overall mean follow-up was 12 months. The mean interval time between flap reconstruction and debulking procedure was 121 ± 53 days (median, 117 days). Overall, mean digital length of 25 mm (range, 20 to 30 mm) was preserved. The reconstructed digits achieve comparable diameter with regard of the contralateral side after debulking procedure. The two-point discrimination of the injured fingers of adults after 12 months of follow-up was 10.4 ± 1.6 mm. The patients satisfied the procedures as very satisfying in 12 cases and good in 3 cases. Conclusion: One-stage secondary debulking procedure can provide an innovative option for reconstruction of non-replantable fingers, with good functional and aesthetic results.

關鍵字

non-replantable amputation of digit ； one-stage secondary debulking procedure

並列摘要

背景：手部傷害佔急診外傷病患10－20%的就診人次，其中1.3%的病患最終需截肢處理。斷指的處理，再植手術為最理想的方式，但是並非所有個案皆適合此類手術，手術成功機率受到多項條件的影響，包括受傷的機制、截指保存方式、缺血時間、醫療機構的顯微手術器材及經驗，任何條件不利皆可能影響再植手術的施行。根據文獻指出，無法施行再植手術的斷指，除了截肢外，亦可以運用局部或游離皮瓣進行重建，但經此等手術重建後的手指，易具有肥厚的皮瓣，外觀不佳且影響功能。目的及目標：本文回顧本院過往的經驗，針對無法再植之斷指使用自體指骨合併局部皮瓣進行重建，並以單階段減積手術（One-stage debulky）修整皮瓣之手術治療成果。材料及方法：本文為回溯性研究，自2010年起至2017年止，收納外傷後無法再植之斷指病患為研究對象。所有病患皆使用局部皮瓣進行重建，經皮瓣分離手術，等待一段間隔期後，再接受單階段減積手術，手術結果根據重建斷指之外觀及功能進行主觀性的評估，同時根據手指保留長度、併發症、皮瓣分離及單階段減積手術間隔期等進行分析比較。結果：總共收納15名病患，共26隻無法再植之斷指使用局部皮瓣進行重建。其中，腹股溝皮瓣共12例，腹部皮瓣共3例，大腿前外側根蒂皮瓣共1例。術後追蹤時間平均為12個月，局部皮瓣重建後至單階段減積手術之間隔期平均為3個月。單階段減積手術後並無病患發生皮瓣壞死之併發症，平均每支斷指可額外保留25mm的長度，斷指之橫徑已與正常手指接近，斷指之兩點區辨覺，經12個月追蹤期後平均為10.4±1.6mm，所有病人對於手術重建成果均感到滿意。結論：不可再植之斷指經由本院綜合性手術之治療，不需顯微手術的協助，亦可完成功能性及外觀皆良好之重建成果。