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Background:This research aims to monitor the microcirculation of the replanted finger, which was entirely severed by using laser speckle contrast imaging(LSCI)for early detection and revision of vascular compromise for successful finger replantation. Methods:These six months of research was taken for a survey of 40 cases of replanted fingers of patients of distinct ages and sex. Scrutinizing was done postoperatively by LSCI, every hourly for seven days, to assess changes in blood perfusion both in replanted fingers and healthy ones and analyzed graphically.Results:Initially, from postoperative d=0 to d=2, the perfusion value was at baseline, which ranged 40±15 perfusion unit (PU), showing a wave-like curve, then gradually increased up to 350±50 PU or above in case of those which survived successfully, showing continuous peak slope. However, a gradual drop in perfusion, <35 PU from d=2 or d=3, was seen in those despite undergoing heparinized finger pin-prick bleeding therapy and failed to thrive, showing a downslope curve. Whereas some were under meticulous observation, which flourished lately. Concurrently, a comparison was made with the healthy fingers’ of the same patient, ranging from 200±50 to as high as 400±50 or above. Clinical correlation, as well as perfusion readings of LCSI, were done simultaneously.Conclusions:LSCI provides sensitive and reproducible finger microcirculation measurements and is reliable in predicting reductions in blood perfusion induced by venous or arterial occlusion. It is, therefore, an informative device to detect microvascular compromise during and after replantation surgery
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Objective To observe the clinical effect of replantation and non-finger replantation in the treatment of complete distal segment finger amputations,and to analyze the related factors affecting the survival rate of replantation of amputated finger,so as to provide an objective reference for clinical treatment. Methods From March 2015 to June 2016,sixty-two patients with complete distal segment finger amputations treated in the Third People's Hospital of Huizhou were randomly divided into two groups: the observation group and the control group according to the random number table method. The observation group was treated with finger replantation (Pancreatic repair,orthotopic suture and stump remodeling); the two groups of patients with early finger survival rate,replanting fingernail growth,two points discrimination,distal fingertips The clinical data of 288 patients with replantation of single finger rupture were analyzed retrospectively. The clinical data were divided into two groups:the survivors group,the survivors group 74 cases,compared the clinical data of the two groups of patients,analysis of the impact of replantation of the survival rate of the relevant factors. Results The survival rate of early finger was 8. 57% ( 3/ 35) in the observation group and 15. 15% ( 5/ 33) in the control group, the difference was not statistically significant (χ2 = 0. 216,P>0. 05). At 6 months after operation,the length of nail growth,the two-point discrimination and the distal interphalangeal mobility were significantly better than those in the control group((13. 5±2. 9)mmvs. (11. 8±2. 2)mm);(4. 6±0. 3)mmvs. (7. 5±0. 6)mm;(62. 5±4. 4)°vs. (45. 3±3. 6)°) (P<0. 05) . After 6 months,the observation group The excellent and good rate of finger joint activity was 93. 55% (29/ 31). The excellent rate of joint activity was 70. 97% (22/ 31) in the control group,the difference was statistically significant (χ2 = 3. 979,P<0. 05) 288 cases of replantation of clinical data found that smoking history,type of injury,warm ischemic time,degree of disruption,cross-section thrombosis,postoperative skin temperature,pulp elasticity and postoperative psychological status can affect the replantation ( P< 0. 05) . Multivariate logistic regression analysis showed that the factors affecting the survival rate of replantation of finger injury were significantly higher than those of severe depression(OR5. 698,95%CI:2. 892- 8. 738,P< 0. 001)>complete disconnection(OR5. 389,95%CI:2. 672-7. 964,P<0. 001) >warm ischemic time more than 6 hour (OR4. 515,95%CI:1. 366-8. 847,P<0. 001)>postoperative section Thrombosis 成(OR3. 287,95%CI:2. 543~9. 678,P< 0. 001) > low postoperative skin temperature ( OR2. 142,95% CI:1. 243 - 5. 212,P < 0. 001) > poor postoperative knee elasticity(OR2. 008,95% CI:1. 117- 5.449,P< 0. 001) . Conclusion In the treatment of patients with complete injury from the end of the finger,the effect of replantation of the finger is significantly improved,which can improve the postoperative joint activity and improve the appearance and function of the finger. The period of severe depression,complete disconnection and warm ischemia is long Affect the survival rate of finger replantation of the main risk factors for the above factors targeted measures can improve the survival rate of finger replantation.
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Objective:To investigate the influence of auxiliary application of Xuesaitong injection on blood coagulation indices and thromboembolic complications in the patients after finger replantation. Methods:Totally 64 patients with finger replantation were cho-sen from March 2012 to March 2014 in our hospital and randomly divided into the control group (32 patients) treated with low molecu-lar weight heparin and Xuesaitong group (32 patients) treated with Xuesaitong injection additionally. The clinical curative effect, sur-vival time of finger replantation, the levels of blood coagulation indices before and after the operation and the incidence of thrombotic complications in both groups were compared. Results: The clinical curative effect of the control group and Xuesaitong group was 68. 75% and 93. 75, respectively, and that of Xuesaitong group was significantly better than that of the control group (P0. 05). Conclusion:Auxiliary application of Xuesaitong injection in the patients after finger replantation can efficiently speed up the replantation survival process and improve blood coagulation indices after the operation, which is helpful to reducing the risk of thrombotic complications.
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Objective To explore the strategy of damage control in clinic treatment of severe limb (finger) with multiple injuries.Methods Severe multiple injuries patients with ISS evaluation more than 16 points were chosen for this study.Simple replatations of severed limb(finger) were perfored in 40 patients while their multiple injuries were actively treated.Results Among the 40 cases, all cases survived.1-3 years follow-up showed that the results were excellet in 8, good in 21, middle in 7, and poor in 4, with an excellent or good rate of 72.5 percent.Conclusion Multiple specialties cooperation, early treatment of multiple injuries and experienced microsurgery operation are the keys to improve success rate of replantation of severed limb(linger) with multiple injuries.