CAJ | 학술논문

目的探讨仅吻合指动脉终末支指尖再植的侧支回流的流体力学机制.方法 2009年9月至2013年3月,对58指指尖离断病例进行再植,术中仅吻合1条指动脉终末支,注意保留指动脉弓的完整性和吻合口近端的分支,术后不做甲床放血和小切口放血.结果 58指指尖再植病例中存活55指,坏死3指;成活率为94.8％.术后随访3～ 12个月(平均7.8个月),存活指体饱满,指甲生长良好,外形满意,静态两点分辨觉为3～7mm.结论仅吻合指动脉终末支指尖再植的成功率高,保留指动脉弓的完整性,能提供有效的分流,用流体力学的伯努利定理(P+ 1/2 ρv2+ ρgh＝常量)分析指尖再植指动脉侧支回流现象,指动脉吻合口近端的侧支能提供侧支回流,这种现象是吻合单根血管指尖再植存活的主要机制.
목적 탐토부문합지동맥종말지지첨재식적측지회류적류체역학궤제.방법 2009년9월지2013년3월,대58지지첨리단병례진행재식,술중부문합1조지동맥종말지,주의보류지동맥궁적완정성화문합구근단적분지,술후불주갑상방혈화소절구방혈.결과 58지지첨재식병례중존활55지,배사3지;성활솔위94.8％.술후수방3～ 12개월(평균7.8개월),존활지체포만,지갑생장량호,외형만의,정태량점분변각위3～7mm.결론 부문합지동맥종말지지첨재식적성공솔고,보류지동맥궁적완정성,능제공유효적분류,용류체역학적백노리정리(P+ 1/2 ρv2+ ρgh＝상량)분석지첨재식지동맥측지회류현상,지동맥문합구근단적측지능제공측지회류,저충현상시문합단근혈관지첨재식존활적주요궤제.
Objective To investigate the hemodynamics of collateral flow in fingertip replantation with anastomosis of digital artery terminal branch only.Methods From September 2009 to March 2013,replantation of 58 severed fingertips was carried out.Intraoperative only one terminal branch of the digital artery was anastomosed.Care was taken to preserve the integrity of the digital artery arch and the branches proximal to the anastomotic site.Neither nail bed bleeding nor small incision bleeding was done postoperatively.Results Among the 58 replants,55 fingertips survived while 3 were lost due to necrosis,the survival rate being 94.8％.Postoperative follow-up period ranged from 3 to 12 months (average,7.8 months).The survived fingertips were full,with normal growing nails and good appearances.Static two-point discrimination was 3 to 7 mm.Conclusion High survival rate can be achieved in fingertip replantation with anastomosis of one digital artery terminal branch only.Preserving the arterial arch provides sufficient collateral flow.Analysis of the collateral flow in the replanted finger using Bernoulli's Law (P + 1/2 ρg2 + ρgh =constant) of hemodynamics shows that collateral branches proximal to the anastomosis can provide collateral drainage.This is the main mechanism for the survival of replanted fingertips when only one terminal branch of the digital artery is anastomosed.