Special type of finger defect reconstruction

The use of normal or partial disability indicators and other residual fingers with vascular nerves or sutured nerves to reconstruct the thumb has long been used in clinical practice and is a traditional method of reconstruction. With this re-engineering method, the surgical success rate is high and the sensory function is good. Reconstruction of the thumb with the normal index finger is longer and reduces the index as a deficiency. If the thumb is used to rebuild the thumb, although the finger is reduced, the discarded residual finger is used to make the best use of it. The purpose of the use, which eliminates the ugly residual finger and recreates the thumb, is a surgery worthy of implementation. Treatment of diseases: hand injury, hand injury, hand injury, tendon injury Indication Suitable for special types of finger defects. Contraindications 1. There are obvious traumatic hypertrophy scars on the dorsal side of the palm and the palm of the hand, and the residual fingers of the common arteries, the normal arteries, the finger nerves and the dorsal veins of the fingers are injured. 2. Thumb stump and residual refers to those with soft tissue and deep tissue infection. 3. Have bleeding tendency and diabetes patients. Preoperative preparation 1. X-ray film to understand the condition of the finger and the joint bone and joint. 2. Use the Doppler blood flow meter to detect the presence of the common arteries and finger arteries. 3. Patients with stenosis of the tiger's mouth should also plan the surgical design for opening the big tiger's mouth and flap. Surgical procedure Take the finger indexing technique as an example. 1. Design two flap incisions at the fingertip and thumb root. Make the flap of the root of the thumb larger, including the skin of the tiger's mouth: the flap of the root is smaller and triangular. 2. The extensor digitorum extensor tendon was exposed in the dorsal incision of the thumb, and the finger nerves on both sides of the thumb were revealed in the volar incision. Use a rongeur to bite off the thumb (palm) of the thumb and correct the medullary cavity. 3. Carefully separate the vein in the dorsal incision of the index finger and ligature the vein branch connected to the middle finger, and detach it together with the fascia. In the second metacarpal, the posterior part of the dorsal metacarpal and the intrinsic extensor muscles were removed. On the volar side, the index finger and the intrinsic artery were carefully separated, and the finger was ligated to the middle finger. Refers to the common artery as the main blood supply artery. The first finger of the total nerve is bluntly separated, so that it is split into two strands, and the finger-finger-finger nerve is displaced together with the native artery of the finger. The stagnation of the first dorsal interosseous muscle and the volar interosseous muscle were cut off. According to the length of the thumb defect and the length of the index finger, the osteotomy plane of the second metacarpal bone is determined, and the metacarpal bone is peeled off, and the metacarpal bone is cut by a wire saw or a bone chisel. 4. Properly separate the finger flexor tendon, protect the dorsal vein of the finger, refer to the intrinsic artery and the finger nerve, move the finger to the stump of the thumb so that it is in the pronator and the palm rest, and make the bone shortening and bone dressing according to the length required for reconstruction of the thumb. After the internal fixation, suture the periosteum. 5. After adjusting the length of the extension and flexor tendon, use the 3-0 non-invasive nylon single-line "8" shape to suspend the finger tendon and adjust its tension to the rest position. The first metacarpal and intermaxillary muscles and the middle finger are the first. The dorsal interosseous muscle was sutured, and the abductor tendon of the thumb was sutured with the first dorsal interosseous muscle. The first dorsal interosseous muscle was sutured with the original first metacarpal tendon. To replace the thumb and adduct. 6. The last two flaps are interchanged to form a new tiger's mouth, which is sutured. complication 1. The bones are not connected due to poor internal fixation. 2. Infection. 3. Tendon adhesions. In the finger-reversal thumb reconstruction, it is generally preferred to select the residual index finger of the proximal section as the first choice. In principle, the normal index finger transposition is not used for reconstruction. When selecting the remaining middle finger or ring finger index, the intra-arterial dorsal vein and suture extension, flexor tendon tendon should be anastomosed, which increases the difficulty of surgery and the chance of tendon adhesion.

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