重度手の外傷管理におけるマイクロサージェリー技術の応用：臨床データの回顧的研究分析
Jian Liu1, Gang Zhao2, Zhengfeng Lu2
1Department of Hand and Foot Microsurgery, Wuxi Huishan District People's Hospital; Affiliated Huishan Hospital of Xinglin College, Nantong University, No.2 Zhanqianbei Road, 214100, Wuxi, China.
Objective:
The objective of this study is to investigate the application and outcomes of microsurgical nerve and vascular repair, replantation, and reconstruction in the management of severe hand injury.
Methods:
A retrospective analysis of clinical data was conducted for 103 patients with severe hand injury admitted to our hospital from July 2018 to December 2021. All patients received treatment using microsurgical techniques. The postoperative surgical time, emergency operation blood loss, length of hospital stay, average number of surgeries, early sensory function (assessed at a minimum of 3 months postoperatively), flap appearance, flap survival rate, scar contracture, hand function, and occurrence of postoperative complications were recorded. The improvement in daily activity capacity before and after treatment was compared.
Results:
The average surgical time was 16.98 ± 3.29 h, often reflecting the complexity of concurrent multi-tissue repairs. The average number of surgeries per patient was 2.8 ± 0.9 (range: 1-5), emergency operation blood loss was (97.38 ± 9.85) mL, and the length of hospital stay was (19.87 ± 0.47) days. The excellent rate of early sensory function was 76.70%. The daily activity capacity score (Barthel Index) improved significantly from 46.98 ± 10.32 preoperatively to 73.76 ± 9.87 postoperatively (p < 0.001). The overall flap survival rate was 97.09% (100/103 primary flaps), with a flap appearance satisfaction rate of 97.09% among surviving flaps, and an incidence rate of persistent flap edema of 2.91%. Scar contracture was mild in 47.57% of cases, moderate in 50.49%, and severe in 1.94%. The hand function score (DASH) was (73.28 ± 18.76). The incidence rate of postoperative complications was 26.21%.
Conclusion:
Microsurgical Techniques are indispensable in the treatment of patients with severe hand injury, facilitating the restoration of early sensory function, daily activity capacity, achieving high flap survival rates and good flap appearance, managing scar contracture, and improving hand function. Despite the complexity and lengthy operative times, these techniques offer a viable path towards functional limb salvage.
