探讨悬空两点支撑平衡下2针吻合微小血管神经再植微小指尖的临床疗效及可行性。

回顾性分析2021年7月至2024年9月，南京江北医院手足显微外科收治26例26指微小指尖离断进行再植。在悬空两点支撑平衡下，先于断裂微小血管神经上12（9）点及6（3）点处两点定位，在两点定位处分别进行1针端端吻合，共计2针吻合微小血管神经，恢复血管神经连接及平衡，吻合血管神经的比例为1：1（1条弓上动脉和1条指尖神经）。所有病例均采用门诊或微信图片随访，记录指体外形、功能、感觉恢复情况。参照中华医学会手外科学分会对断指再植术后功能评定标准进行评定。

本组26例微小指尖再植全部成活，术后再植指尖血循环稳定，无1例发生血管危象。随访时间为6~22个月，平均为8.5个月，末次随访再植指尖外形、功能恢复均佳，与健指一样，参照中华医学会手外科学分会对断指再植术后功能评定标准评定：优23指，良3指，优良率100%。

悬空两点支撑平衡下2针吻合微小血管神经能有效再植微小指尖，不仅无血管危象，而且感觉恢复可，提高了成活率，后期外形、功能恢复均佳。

To investigate the clinical curative effect and feasibility of two-needle sutures anastomosis of microvessels and micronerves to replant tiny fingertips under suspended two-point support balance.

A retrospective analysis was performed on 26 patients (26 digits) with completely severed ting fingertips who were admitted to the Department of Hand and Foot Microsuegery of Nanjing Jiangbei Hospital from July 2021 to September 2024. Under the balance of suspended two-point support, two points were located at 12 (9) o’clock and 6 (3) o’clock on the ruptured microvessels and micronerves. One needle suture was performed at 12 (9) o’clock, and the other was performed at 6 (3) o’clock. A total of two needle sutures were performed for end-to-end anastomosis of microvessels and micronerves to restore superior digital arch artery and fingertip nerve connection and balance. The ratio of anastomosed vessels and nerves was 1:1. All patients were entered into scheduled follow-ups through a combination of visit of outpatient clinics or WeChat and telephone reviews, and the recovery of finger shape, function, and sensation was recorded. The clinical efficacy was evaluated according to the standard functional evaluation issued by the Hand Surgery Association of Chinese Medical Association.

All 26 ting fingertips survived completely, and the blood circulation of replanted fingertip was stable after operation. No vascular crisis occurred. The follow-up period ranged from 6 to 22 months, with an average of 8.5 months. At the final follow-up, the appearance and functional recovery of replanted fingertips were good, with the appearance being close to that of the contralateral healthy finger. According to the standard functional evaluation issued by the Hand Surgery Association of Chinese Medical Association: the function was excellent in 23 cases and good in 3 cases, with an excellent/good rate of 100%.

Two-needle suture anastomosis of microvessels and micronerves under suspended two-point support balance is an effective method to replant tiny fingertips, and it can achieve sensory recovery, increased survival rate, and good long-term appearance and functional recovery with no vascular crisis.