Replantation of severed mid-digit distal segment

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 interrupted by trauma or Sunday surgery, causing most or all of the tissue to be broken is called a broken limb. The limb of the broken limb has poor blood supply, or no blood supply. If the limb is not replanted, it will be necrotic. The limbs include: large limb disconnection and finger, toe, or part of the finger, the toe of the toe, and the replantation of the broken limb. The surgical conviction method is used to anastomize the blood vessel, including the artery, and the vein is used to keep the limb bloody. It also includes the repair or (and) internal fixation of bones and joints, as well as the repair of nerves, muscles, tendons, skin and other tissues. The limb amputation is a serious limb injury this year. In order to ensure the survival of the limb and to take care of the function of the surviving as much as possible, sometimes special replanting methods are adopted, such as: simultaneous disconnection of multiple limbs, in order to obtain better The function can replant the position of the broken limb according to the specific injury. This is called limb displacement and replantation. In order to eliminate the replanted limbs, the secondary vessels are recommended to be transplanted. Solving is difficult, and so on. Treatment of diseases: hand trauma, open hand injury Indication 1. The whole body condition is allowed and there is a request for replantation. 2, the finger off the blood vessels, nerves, tendons or skin avulsion from the proximal end, the fingers are intact, not irritating liquid soaked. Contraindications 1. The whole body condition is not allowed, and I and my family have no replantation requirements. 2, the finger is broken, the vascular nerves, tendons are avulsed from the distal end, it is difficult to establish blood circulation. 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 After debridement, the phalanx was fixed through the longitudinal shape of the Kirschner wire. Use 11-0 non-invasive needle, line anastomosis of the volar artery, one vein, two nerves. One day after the operation, the fingertips were lightly pressed, and the skin at the pressure point became pale. Release the oppression, the fingertips quickly restore blood circulation, and prove that the replantation refers to blood supply by anastomotic blood vessels. One year after surgery, the fingertips are full, the nails are intact, and the function is good. complication (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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