透過您的圖書館登入
IP:52.54.111.228
  • 期刊

Primary and Secondary Subdermal Pocket Procedure Used in Digital Replantation with Venous Congestion

真皮下包覆式方法於斷指之靜脈充血的初級及次級應用

摘要


背景: 對於顯微重建外科醫師而言,在重建斷指時遇上沒有可運用的靜脈來達成靜脈回流是個極大的挑戰。雖然有關於如何處理重建斷指時遇上沒有可運用的靜脈的文獻紀錄,但仍沒有一個完美的方法。 目的: 這篇文章主要是比較重建斷指時於沒有可運用的靜脈時使用初級及次級真皮下包覆式方法的結果分析。 材料與方式: 從1999至2008,一共收集了16個病人,總共有17個手指截肢(16個完全截斷,1個幾乎完全截斷),其中包含了7個利器性截肢及10個壓傷性截肢。病人年紀分布從23至58歲,平均年齡為36.8歲。所有病人根據接受真皮下包覆式方法的時機共分為兩組。 結果: 第一組為病人為在重建斷指時遇上沒有可運用的靜脈時,只接受指動脈吻合後立即使用真皮下包覆式方法。此組共有11個手指截肢,平均使用真皮下口袋術法的天數為9.1天。成功率為100%。第二組為接受斷指重建術後發生靜脈充血現象而使用真皮下包覆式方法。此組共有6個手指截肢。從斷指重建術後至實施次級皮真下包覆式方法時間間隔的平均為39.0小時。平均使用真皮下口袋術法的時間為6.8天。成功率為66.7%。 結論: 在斷指重建時遇上沒有可運用的靜脈時立即使用真皮下口袋術法會比在斷指重建術後發生靜脈充血現象再使用此法有著較高的成功率。我們建議在沒有可運用的靜脈時及早使用真皮下包覆式方法可有較好的結果。

關鍵字

無資料

並列摘要


Background: The major challenge faced by reconstructive microsurgeons for salvaging digital amputations, especially at the level of fingertip, was the lack of available vein. The search for an ideal solution for no suitable vein at the time of replantation remained despite numerous proposal in the literature. Aim and Objective: The aim of this study is to compare the primary use of subdermal pocket procedure at the time of replantation for venous outflow, and as a secondary procedure for the salvage of postoperative venous congestion after replantation. Materials and Methods: From 1999 to 2008, a total of 17 amputations (16 complete digital amputations; 1 near-complete amputation) from 16 patients (9 male; 7 female) were collected, which included 7 guillotine and 10 crushed digital amputations. Their age ranged from 23 to 58 years old, averaging 36.8 years old. All patients were divided into 2 groups based on the timing of subdermal pocket procedure. Results: The first group (Group Ⅰ) has received digital artery revascularization and immediate subdermal pocket procedure as a mean of venous drainage. It was consisted of 11 digital amputations. The mean subdermal pocketing period was 9.1 days, and the success rate was 11 of 11 fingers (100%). The second group (Group Ⅱ) received secondary subdermal pocket procedure as a salvage procedure when postoperative venous congestion became apparent after replantation. This group consisted of 6 amputated digits from a total of 5 patients. The mean time lapse between replantation and the delayed subdermal pocket procedure was 39.0 hours. The average pocketing period was 6.8 days, and the success rate was 4 of 6 fingers (66.7%). Conslusion: The immediate use of subdermal pocket procedure after digital replantation when no vein was available has a greater survival rate as compared to the delay use of subdermal pocket procedure after postoperative venous congestion has occurred. It was recommended to performed primary subdermal pocket procedure to increase the survival rate of finger replantation.

延伸閱讀