原位缝合固定加包埋法治疗手指指甲半月线以远完全离断.docVIP

原位缝合固定加包埋法治疗手指指甲半月线以远完全离断 　　[摘要] 目的 探讨手指末节指甲半月线以远完全离断原位缝合固定+皮下包埋再植方法及疗效。 方法 选择我院2008年1月～2013年1月36例40指末节指甲半月线以远离断指，经彻底清创、拔除指甲、去除角质层、内固定、皮肤软组织原位缝合，并将末节指腹和指缘皮肤切开2～3刀至皮下，埋入对侧胸壁或腹壁皮下，16～35 d取出离断指。 结果 36例40指，成活38指，部分坏死1例，后行邻指皮瓣；完全坏死1例。术后随访3个月～2年，手指末节血运、弹性、外观及活动良好，痛温觉恢复，手指功能恢复满意。 结论 采用去角质层原位缝合皮下包埋法治疗指甲半月线以远完全离断方法简单实用，疗效优良，特别适合无法吻合血管的末节离断及无纤维吻合技术的基层医院。 　　[关键词] 手指离断；指甲半月线；原位缝合；皮下包埋 　　[中图分类号] R658.1 [文献标识码] B [文章编号] 1673-9701（2015）14-0024-03 　　[Abstract] Objective To explore the treatment outcome of in situ suture fixation combined with embedding method in the treatment of complete amputation of fingertip distal to nail semilunar line. Methods From Jan 2008 to Jan 2013， 36 cases （40 fingers） with complete amputation of fingertip distal to nail semilunar line in our hospital. After thorough debridement， removal of the nail and stratum corneum， internal fixation， skin and soft tissue in situ suture， cut 2 to 3 knivies to the subcutaneous in the abdomen and edge of the distal finger， then the wounded finger was buried in the subcutaneous of the lateral thoracic or abdominal wall， take out the wounded finger after 16 to 35 days. Results 36 cases （40 fingers）， 38 fingers survived， 1 case happened partial necrosis （used adjacent finger flap）， 1 case happened complete necrosis. The postoperative follow-up for 3 months to 2 years， the blood transport， elasticity， appearance and activity of the fingertips were good， pain and temperature sensation recovery， finger function recovery well. Conclusion For the repair of the complete amputation of fingertip distal to nail semilunar line， in situ suture fixation combined with embedding method is simple and practical， the treatment outcome is also good， it is especially suitable for fingertip amputation， which blood vessel can not be repaired， and primary hospital without fiber anastomosis technique. 　　[Key words] Fingertip amputation； Nail semilunar line； Situ suture； Subcutaneous embedding 　　离断指再植应根据分区采取不同的手术吻合方法，可提高再植成功率[1]。手指指甲半