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A patient with 20-segments multi-planar amputation of the 2nd-5th fingers of the right hand was treated in December 2020 in the Department of Hand and Microsurgery, Affiliated Taihe Hospital of Hubei Universtiy of Medicine. The groupings was performed with microscopic anastomosis and splicing, and the replantation was finally completed. Followed-up at 1 year after surgery, the 17 segments of 20 severed finger segments finally survived. According to the Chinese Medical Association's Hand Surgery Branch's Functional Evaluation Criteria for Replantation of Amputated Fingers, the patient's finger function rating was 57 points and the function was poor at 1-year follow-up. The range of motion of the metacarpophalangeal joint was significantly improved compared with half a year after the operation. The simple grasping, pinching and fingering can be completed. The finger sensation was improved compared with half a year after the operation, but the finger body of right hand atrophied progressively, the interphalangeal joint was stiff, wirheut flexion nor extension range of motion. The function of the replanted finger was limited.
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In July 2016, we used free superficial palmar branch of radial artery flap to repair one case of complete dissection of the thumb with skin defect, and achieved good result .
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Objective To investigate the nursing of replantation methods of sea-water soaked rotated avulsion amputated fingers.Methods There were 8 cases (16 fingers) with sea-water soaked rotated avulsion amputated fingers.5 cases were replanted by synchronic replantation method,the other 3 cases were replanted by traditional replantation method.We adopted complete debridement and high quality vascular anastomosis during the operation,and give hyperbaric oxygen therapy and anticoagulant treatment post-operation.Results There were 15 survival fingers in 16 replanted fingers.The survival rate was 93.75％.After follow-up for three months to two years,the total good rate was 87.5％.No wound infection and nonunion of fracture occurred.The outline of the fingers was satisfying and patients felt well.The twopoint discrimination was 3～6 mm after 3～24 months follow-up.Conclusions The injury of sea-water soaked rotated avulsion amputated fingers is complicated and the replantation operation is difficult.but if we can adopt individual measure according to the actual circumstance,it is possible that the sea-water soaked rotated avulsion amputated fingers can survive.
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Objective To probe into nursing management methods of replantation of amputated finger patients accepting brachial plexus block analgesia and patient-controlled sedation (PCS) after operation.Methods 48 patients of replantation of amputated fingers accept continuous brachial plexus block analgesia and PCS after operation,Analgesia was 0.2% ropivaeaine,sedation was 0.05% midazolam or compositive liquid mixed 0.05% midazolam and 0.0005% fentanyl,the visual analogue scale (VAS),sedation scores and the changes of vital signs and side effocts after operation were recorded before the operation and at time intervals of 6,12,24,48,72 hours after the operation.Results The visual analogue scale(VAS)in the post-operation was obviously lower than the pre-operation,the Ramsay scores of PCS were higher than the pro-operation.There was no inadequate or excessive sedation.No influence was seen on respiration,circulation system and no other side effects happened.Conclusions Brachial plexus block analgesia and patient-controlled sedation (PCS) can offer a good Analgesia and sedation effect for patients of amputated fingers replantation,in period of analgesia and sedation,we should strengthen nursing and monitoring of vital signs to avoid accident.
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Since the first successful replantation of incompletely amputated digit was performed by Kleinert in 1962, Komatsu and Tamai reported the successful replantation of a completely amputated thumb in 1965. Nowadays, further improvements in instrumentation and surgical skill are accomplished and replantation of digit has been popularized widely. But sometimes the functional results of replanted digits are not excellent expected and there is a place for discussing gain between the result and efforts to replantation. We have been analyzed 28 cases of finger replantation in 17 patients from June, 1982 through June, 1984 at the Department of Orthopedic Surgery, Kyungpook National University Hospital. The results were as follows: 1, Male were 12 and female were 5, and average age was 20.5 years old. 2. The most common injury was done by cutting machine. 3. The number of amputated fingers were as follows: thumb, 6 cases; index finger, 11 cases; middle finger 7 cases; ring finger, 3 cases; The level of amputation was as follows: Zone II, 6 cases; Zone III, 15 cases; Zone IV, 7 cases; 4. The maximum ischemic times for successful results of finger replantation were 19 hours. 5. The total ratio of successful replantation of digits in our cases was 82.1%. 6. The functional results of replantation including joint motion, sensory recovery, two point discrimination, pinch power, sweating were relatively satisfactory. (Normal 8, Fair 11, Poor 3, Protective 1 case) 7. The main cause of replantation failure was thrombosis of the vein.
Subject(s)
Female , Humans , Male , Amputation, Surgical , Clinical Study , Discrimination, Psychological , Fingers , Joints , Orthopedics , Replantation , Sweat , Sweating , Thrombosis , Thumb , VeinsABSTRACT
The arteries of thirty human adult upper extremities, injected with red lead oxide, were treated with angiography, sectional dissection and photography. A microcomputer was used to determine the positions of the vessels and reconstruct the arterial system of the hand.The arteries of the palm are arranged in 2 or 3 layers. The area of three layers were only observed in the middle portion of the palm. The divisions of the territories of the radial and ulnar arteries are not the same in different layers. The anastomotic branches in the palmo-dorsal direction are usually observed in the third, fifth and seventh sections. There are three chief anastomotic channels between the radial and ulnar arteries in the palm, i.e. the deep palmar arch, the superficial palmar arch and a third pathway. The patterns of the blood supply in the palm and its clinical significance have also been discussed.