手外伤:病历报告(7例)

NONDIDITAL TISSUE  REPLANTATION   AND   MICRO -SURGICAL   SPARE   PART  UTILIZATION  IN   MUTILATED   HANDS: CASE   REPORTS   AND   REVIEW

SERDAR NASIR, M.D.,[1]* MUSTAFA ASIM AYDIN,M.D.,[1 ]and AYAN GULGONEN, M.D.[2]

Five cases with microsurgery utilization of spare parts from unrepalantable amputated segments are presented. Bsides,nondigital composite tissue replantations are firstly reported in hand. They all resulted in satisfactory outcomes compared to alternative treatments without any donor site morbidity. (c)2007 Wiley-Liss,Inc.Microsurgery 27:65-73,2007.

Figure 1. Case 1(A,B) Preoperative appearance and X-ray of the hand in case .(C) Postoperative early view.  (D,E) Late postoperative X-ray demonstrating MP joint degeneration and late range of motion at MP joint (12months).

Figure 2. Case 2(A) Preoperative view of mutilated hand. (B)Preoperative X-ray roentgenogram of  injured hand and amputated segment (upper left corner).(C)Preparing amputated segment for replantation with KVV.(D)Postoperative X-ray.(E-G)Postoperative hand function.

Figure 3. Case 3(A,B)Preoperative appearance and X-ray with destructed middle phalanges of index and long fingers. (C)Left :Amputate distal phalanx of the long finger. Right The fillet flap. (D)Left :Early postoperative view demonstrating the flap transferred from the long finger .Right :Schematic view of replanted fillet flap.(A, Anastomosis; DV,Digital artery ;DN, Digital nerve). (E)Postopertive X-ray demonstrating the replacement of the middle phalanx with bone component of the transferred composite flap (white arrow). (F) Late postoperative.

Figure 4.Case 4(A) Preoperative view of the injured hand. (B) Preoperative X-ray with unreplantable 2 pieces from the index finger. (C)Left: Amputate parts of index finger. Right : The fillet flap preparing from the big amputated part. (D) Schematic view of replanted fillet flap.(A,Anastomosis; DV,Dorsal vein ;DA ,Digital artery; VG,Vein graft ;DN, Digital nerve). (E) Postoperative view.

Figure 5. Case 5(A,B)Preperatie view and X-ray of the mutilated hand in case . (C) Schematic view of the first metacarpal reconstruction. (D) Postoperative X-ray. (E,F)Powerful pinching and grasping at postoperative 2 years.

Figure 6. Case 6(A) Preoperative view of massive  injured hand. (B) Schematic view of free spare part flap and replanted finger. (C,D) Postopertive view.

Figure 7. Case 7(A) Preopertive view of injured hand with en bloc amputated fingers segment. (B)Prepared spare part flap. (C,D)Postopertive view.