Replantation of finger avulsion amputation

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 The thumb is wound into a rotating machine tool to cause avulsion and breakage. The blood vessels and nerves are extracted from the proximal fracture, and the flexor and extensor tendons are avulsed from the junction of the muscle tendons. There are no obvious contusions at both ends. If the blood vessels and nerves are torn off from the distal end, it is not suitable for replantation. First remove the muscles on the avulsed tendon, and then routinely brush and disinfect the broken fingers. After routine debridement, the avulsed blood vessel is removed in a banded portion (the endometrium has been exfoliated). A transverse incision is made along the proximal margin of the wound to the dorsal skin of the second metacarpal. Find a "Y" vein on the dorsal side of the first and second metacarpal bones, and cut off from the distal end to prepare for anastomosis with the broken finger vein. Finding the intrinsic index extensor tendon from the distal end in the same incision. The severed tendon is withdrawn from a small incision in the wrist. Through the subcutaneous tunnel of the thumb, the intrinsic extensor tendon of the index finger is displaced to the proximal end of the finger, so as to be sewed with the long extensor muscle of the finger. Make a small transverse incision on the distal side of the lateral striate of the ring finger, cut the flexor tendon sheath of the flexor digitorum, expose the superficial flexor tendon of the ring finger finger, and cut off from the distal end as far as possible. A small transverse incision is made at the lateral line of the palm of the hand, and the severed flexor tendon of the cut ring is extracted from the incision. The finger refers to the superficial flexor tendon through the carpal tunnel (lower transverse ligament) to the thumb section in preparation for replacing the flexor hallucis longus. An incision was made along the large fish pattern, and the intrinsic artery of the index finger side was exposed and separated. The distal end was cut, the distal end was ligated, and the proximal end was displaced to the thumb wound, ready to be anastomosed with the broken finger artery. The exposed detachment shows the ulnar nerve, the distal end is cut, the proximal end is moved to the thumb, and the nerve is ready to be kissed. The phalanx was fixed obliquely with a single Kirschner wire. If it is disconnected from the metacarpophalangeal joint, joint fusion is performed. The displaced index finger intrinsic extensor tendon is sewed with the thumb extensor muscle of the finger, and the "8" word is sutured. The displaced ring finger refers to the shallow flexor tendon and the thumb of the thumb flexor tendon with 3-0 non-invasive suture. Improved Kessler suture method. Regulate the flexor extensor tendon tension in the thumb rest position. The displaced ulnar side finger nerve is sewn with the broken finger ulnar nerve. The displaced "Y" vein is anastomosed to the two veins on the dorsal side of the broken finger. The displaced index finger anastomosis of the iliac artery and the ulnar artery of the severed finger. Relax the tourniquet to observe the recovery of blood circulation. Stitch the skin. One year after surgery, the replanted thumb has good appearance and function. In another case, the thumb was broken and a 7cm x 8cm skin was removed from the back of the hand. The method of replanting the thumb is the same as before; the avulsed skin is trimmed into a full thick layer of skin and implanted back into the wound. Appropriate pressure dressing, taking care not to interfere with venous return. Replanted thumb and full thickness skin grafts survived well. One year after surgery, the thumb and back of the hand are in good shape and can be fully abducted. The thumb is pinched with each finger. 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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