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188宝金博页面版: 4.8 Extended indications and clinical applications of arterialized venous flaps for hand reconstruction

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内容提示: between were classif i ed as medium (n ? 64). Classif i edaccording to composition, there were 88 (57.1%) venousskin f l aps, 28 (18.1%) innervated venous f l aps, 15 (9.7%)tendocutaneous venous f l aps, which incorporated thepalmaris longus tendon for the repair of f i nger extensortendons, and 17 (11%) f l ow-through venous f l aps torepair arterial defects. There were 6 (3.9%) compositetissue defects, which involved soft tissue, blood vessels,and tendons.Results: Flap transfer success rate was 98.1% (1...

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between were classif i ed as medium (n ¼ 64). Classif i edaccording to composition, there were 88 (57.1%) venousskin f l aps, 28 (18.1%) innervated venous f l aps, 15 (9.7%)tendocutaneous venous f l aps, which incorporated thepalmaris longus tendon for the repair of f i nger extensortendons, and 17 (11%) f l ow-through venous f l aps torepair arterial defects. There were 6 (3.9%) compositetissue defects, which involved soft tissue, blood vessels,and tendons.Results: Flap transfer success rate was 98.1% (151/154).The incidence of partial f l ap necrosis was 5.2% (8/154).The mean number of included veins was 2.17 for a smallf l ap, 2.60 for a medium-sized f l ap, and 4.07 for a largef l ap, which was a statistically signif i cant difference(po0:01). The mean area of f l ap necrosis was 45.0%,31.7%, and 18.8% for small, medium, and large f l aps,respectively (p ¼ 0:807). In 12 cases in whom tendocu-taneous f l aps were used, active range of motion at theproximal interphalangeal, distal interphalangeal, andmetacarpophalangeal joint was 601, 201, and 751,respectively.Conclusion: We conclude that the arterialized venousf l ap is a valuable and effective tool in the reconstructionof complex hand injuries and may have a morecomprehensive set of indications.10.1016/j.jhsb.2006.03.1164.9 OPTIMAL CONDITIONS FOR HYPOTHERMICPRESERVATION OF AMPUTATED DIGITSU. Ahe` an 1 , T. Eva 1 , K. Sancin 1 , B. Luzar 2 andP. Zorman 11 University Medical Center, Ljubljana, Slovenia;2 Institut of Patohistology, Ljubljana, SloveniaBackground: The decision to replantate is criticallydependent on the condition of the amputated f i ngerand its preservation during transport. Clinical experi-ence shows that placing the amputated digit directly onice or inserting it in a freeze pack is the commonest errordue to insuff i cient knowledge of the lay public. A higherincidence of intra- and postoperative complications isnoted in these cases.Patients and methods: In a 4-year period, 124 patients(mean age, 39 years; range, 2–75 years) with completef i nger amputations were admitted and all f i ngers werereplantated.Results: Replantation succeeded in 81% and was alsoperformed in 18 of 22 frozen digits. Five of theseremained viable, 13 had to be re-amputated later due tofreezing injuries. Two simulations of incorrect cooling(directly on ice and directly on freeze pack), correctmethod (mixture of ice and water), and alternativehypothermic method (disposable cold packs) were done.A thermometer placed directly on ice or inserted in afreeze pack showed temperatures below 01C for150min. Cold packs (containing ammonium nitrate)were found to produce a suitable thermal environment(3–151C) for hypothermic preservation during the150minute time period. Five amputated digits werehistologically analysed after incorrect hypothermicpreservation. Tissue specimens were f i xed in 10%formalin and embedded in paraff i n. Subsequently,5mm thick sections were stained with hematoxylin andeosin. The arteries from digits submitted on ice hadbarely visible slit-like lumina throughout the subcutis;morphology of veins and nerves in the dermis andsubcutis was normal.Conclusion: Optimal conditions for hypothermic pre-servation of amputated digits are hard to attain in thef i eld. We propose the use of disposable instant coldpacks as a suitable cooling medium and simpleinstructions for safe, correct, and practical managementand transport of amputated digits.10.1016/j.jhsb.2006.03.117ARTICLE IN PRESSTHE JOURNAL OF HAND SURGERY VOL. 31B No. S1 JUNE 2006 20

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