Multi-segment replantation of amputated fingers

Replantation of the broken limb is the re-entry of the limb left and right, and the limb is regained blood for survival. A limb that is displaced by most or all tissues due to trauma or surgery on Sunday is called a broken limb. The limbs of the broken limb have poor blood supply, or no blood supply. If the limb is not replanted, it will be necrotic. The broken limb includes: large The limb is broken and the fingers, toes, or part of the fingers, the toes are broken. Treatment of diseases: replantation of severed fingers Indication 1. The patient's general condition allows, can be replanted. 2. There is a certain degree of completeness from the limbs: cutting or sawing off limbs, neat wounds, slight damage to blood vessels and soft tissues. 3. There is a time limit for replanting: it is generally considered to be 7 to 8 hours at normal temperature. Properly preserved in the cold season or off the limb. 4. Refers to the broken finger at the root, or the broken finger with a greater influence on the function of the opponent. 5. For multiple broken fingers, first replant the fingers with the main function, or replant all. Contraindications 1. Suffering from systemic diseases, poor physical condition, or complicated with serious organ damage, it is not allowed to replant for a long time. 2. Broken finger with multiple fractures or severe soft tissue injury. 3. The integrity of the integrity of the finger vascular bed is severe. If the finger is broken by the crush injury, it is manifested as subcutaneous blood stasis on both sides of the finger. Even if the blood vessel is turned on, the soft tissue is extensively oozing, and the thrombus is replanted, and the finger is still difficult to survive. 4. If the replantation time limit is excessively exceeded and the tissue has undergone degeneration, it is not suitable for replantation. If it is not refrigerated, the finger can still replant after 24 hours of ischemia. If it is injured, it will be refrigerated and the time limit for replanting can be extended to more than 30 hours. However, the shorter the ischemic time, the higher the replantation survival rate, and the longer the ischemia time, the lower the replantation survival rate. Preoperative preparation 1. Actively prevent and treat shock, timely and adequate blood transfusion, and supplement blood volume. 2. The isolated limbs are aseptically processed and stored in a refrigerator at 2 to 4 °C. 3. Prepare appropriate fracture fixation equipment according to the site of the limb. 4. Prepare surgical microscopes and microsurgical instruments. Surgical procedure Multi-segment fingers are broken, as long as the tissue is squeezed, the contusion is not serious, and there are generally replanting conditions. However, if the middle segment is shorter than 10 mm, there is no branching of the blood vessels passing through it, and even if the blood vessel anastomosis is of good quality, it is difficult to ensure blood supply in the segment. When replanting, the phalanx on both sides of the distance is shortened. The middle section should be inserted through the internal fixation with Kirschner wire. The paper cutter caused the right 1 to 5 fingers to be completely disconnected. First, in the absence of blood, for the middle and long replantation. Anastomosis, extensor tendon, finger nerves, movements, veins. Replant the far, middle and near ends of the replanted. A total of 10 arteries were anastomosed, 14 veins were counted, and 27 vascular anastomoses were counted. After all the blood vessels have been anastomosed, relax the tourniquet to pass the blood. After replanting successfully, the appearance and function are good. Complications ( 1) Insufficient blood volume: The main cause of insufficient blood volume in patients with broken limbs is blood loss. Reduced blood volume can not only cause shock, life-threatening, but also cause vasospasm and thrombosis of replanted limbs due to contraction of peripheral blood vessels, leading to failure of replantation. Therefore, the pulse, blood pressure, urine volume, jugular vein filling, skin temperature, color and capillary filling time of the broken finger (toe) should be closely observed after the operation. If the systolic blood pressure is above 14.22 kPa (100 mmHg) and the urine volume is >30 ml, the external jugular vein can be seen on the clavicle. The broken finger (toe) is rosy and warm, and the capillary filling time is less than 2 seconds, indicating that the blood volume is normal. If there is insufficient blood volume, the treatment is mainly infusion and blood transfusion, supplement blood volume, avoid applying pressure-boosting drugs, especially norepinephrine, so as not to cause strong contraction of blood vessels, resulting in anastomotic thrombosis. (2) Acute renal failure: a patient who has a long-term shock, or a long-term ischemic limb ischemia, has a tissue degeneration, or has a high plane of the broken limb and has a large number of muscle injuries. After revascularization of the limbs, special attention should be paid to the occurrence of acute renal failure (expressed as oliguria, urinary retention, hemoglobinuria, low urine specific gravity, elevated blood urea nitrogen, increased blood potassium, etc.). This complication should focus on prevention; such as timely correction of shock, strict control of the indications for replantation of the broken limb, thorough debridement, removal of all inactivated muscles, incision of fascia decompression, and appropriate postoperative infusion, static point rate Urine, accelerates the excretion of toxic substances to prevent the occurrence of acute renal failure. Once it occurs, it should be actively treated, such as limiting the amount of intake, controlling hyperkalemia, correcting acidosis and azotemia. If there is no improvement, if you continue to retain the broken limb and will endanger the patient's life, you should get rid of the replanted limb as soon as possible. (3) Prevention of infection: As mentioned above, the key to preventing infection of the broken limb is a thorough debridement. Prophylactic antibiotics should continue throughout the body after replantation.

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