Replantation of proximal severed finger

Replantation of the broken limb is a retreat of the limb left and left, and the limb is regained blood for survival. The limb that is displaced by most or all tissues due to trauma or Sunday surgery is called a 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. Broken limbs include: large limb disconnection and finger, toe, or part of the finger, the toe of the toe, the surgical conviction method used for replantation of the broken limb to anastomosed blood vessels including arteries, veins to keep the limbs bloody and live. 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. 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 The right middle finger is completely disconnected from the near section, indicating that the finger is not completely disconnected. Find the blood vessels, nerve ends, and mark them with 5-0 lines in the two wound ends. Remove the contaminated skin from the wound surface by 2-3mm. A layer of contaminated fat and soft tissue is cut around the vascular nerve bundle, about 2-3 mm thick. A layer of contaminated tissue is removed around the dorsal vein of the finger. The finger is removed and the superficial flexor tendon and part of the sheath are removed. The broken end of the bone is bitten 2-3mm. The wound was cleaned and disinfected with 0.1% benzalkonium bromide solution. Debridement is completed. Bone scaffold repair. If the joint is disconnected from the interphalangeal joint, the interphalangeal joint is fused. If the phalanx is broken, the joint is not open, and the single Kirschner wire is fixed internally. Double Kirschner wire cross fixation is more stable. However, a micro drill is required to pierce the needle. With a single needle running through the needle, it should only run through one interphalangeal joint (A), not through the two joints (B), so that the entire finger can not move for a long time; it is not suitable to wear the skin (C) from the joint cavity to reduce joints Infection and tendon injury. According to the phalanx fracture end, stainless steel wire can also be used for internal fixation. Repair of tendon. The "8" suture was performed on the central bundle of the extensor tendon and on both sides with 3-0 non-invasive needles. The flexor digitorum was treated with a 3-0 non-invasive needle for improved Kessler suture. Adjust the tension of the flexor and extensor tendon of the finger to the rest position. Anastomotic blood vessels: Under the operating microscope, use 11-0 without other needles, first 2-3 of the dorsal veins of the fingers, suture the dorsal skin of the fingers to protect the anastomotic veins. With 11-0 non-invasive needles, the intrinsic nerves on both sides of the fingers and the intrinsic arteries. Stitch the palm side skin. After relaxing the tourniquet, observe the recovery of the blood circulation of the replanted finger. Brake the brakes and re-expose the fingertips to observe the blood circulation. 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, prevention of infection: As mentioned above, the key to prevention of broken limb (referring to) infection is thorough debridement. Prophylactic antibiotics should continue throughout the body after replantation.