Replantation of amputated limbs
Introduction
Introduction to replantation of broken limbs Clinically, in January 1963, Chinas Chen Zhongwei and others first reported successful replantation of one case of complete dislocation of the forearm, and the function recovered well. In 1964, Boston Malt also reported a case of a 12-year-old boy who was replanted in the upper arm in 1962. Over the past 30 years, a large number of successful cases have been reported in the world, and the technique of replantation of the limbs has been popularized to some extent. In the first aid, the patient and the broken limbs should be sent to the hospital as soon as possible and safely. The proximal end of the broken limb is pressure-wrapped with a clean dressing to prevent major bleeding, and it is best not to use a tourniquet. For patients who cannot control major bleeding and must use a tourniquet, they should relax once a hour. When relaxing, apply a finger to press the proximal artery trunk to reduce bleeding. For most isolated limbs, the splint is used to fix the injured limb before transport to avoid re-injury during transport. The broken limbs are covered with a sterile dressing to reduce the infection. Try to store the broken limbs in a dry and refrigerated manner. First, insert the broken limbs into a plastic bag. Then fasten the bag and put it into an impervious container, such as an enamel cup. After the cover, put the insulation with ice. In the bottle. In the event of severe shock in the patient, shock should be treated promptly to prevent life-threatening risks during transit. basic knowledge The proportion of illness: 0.005% Susceptible people: no specific people Mode of infection: non-infectious Complications: septic shock
Cause
Cause of replantation of severed limbs
Sharp trauma (15%)
Caused by sharps, such as paper cutters, milling machines, scissor cars, sickles, sharp knives, glass and some punches, the success rate of replanting surgery is greater. For multi-blade injuries, such as flywheels, chainsaws, fans, steel cables, harvesters, etc., severe tissue injuries, tissue damage near the cross section is more serious, although the difficulty of replanting surgery is greater, but through the efforts can be successful .
Blunt trauma (15%)
Caused by blunt injuries such as train wheels, car wheels or machine gears. After rolling, there is still a circle of bruised skin connecting the limbs that have been broken. The surface seems to be still connected. In fact, the skin has been severely squeezed, and it is pressed very thin and loses vitality. It should be regarded as a complete limb fracture. from.
Crush injury (10%)
It is caused by heavy machinery, stones, iron plates or by extrusion of mixers and heavy objects. The plane of the breakaway is irregular, the damage of the tissue is serious, and a large amount of foreign matter is often squeezed into the cross section and the interstitial space of the tissue. It is not easy to remove the net, and the thrombus often occurs in the vein, and the replanting is difficult.
Tears (8%)
It is caused by the machine shaft belt ribs or rollers (such as lathes, threshers) or the motor shaft that are continuously rotating rapidly. The tearing limb is broken off. In the far and near part of the blood vessel disconnection, there are often severe vasospasm and potential endometrial damage, which brings certain difficulties to the reconstruction of blood circulation.
Prevention
Replantation prevention of severed limbs
In daily work and life, we must pay attention to protecting ourselves, pay attention to safety, and try to avoid trauma or accidents. Obey the traffic regulations, do not smash red lights, do not overspeed when driving, do not overtake each other, so as to avoid car accidents. When you go out to play, pay attention to safety and protect yourself and your family. Workers who come into contact with large machines in the factory must pay special attention to safety when they go to work.
Complication
Broken limb replantation complications Complications septic shock
Generally, there will be no complications in timely treatment.
Symptom
Symptoms of replantation of severed limbs Common symptoms Traumatic bleeding, severe pain, easy fainting
Complete disconnection, partial rupture, contusion of the vessel wall, tearing of the intima and arterial spasm, hemorrhage, tension hematoma, and acute arterial insufficiency (pale, low skin temperature, numbness, dyskinesia, severe pain, and distal arterial pulsation disappeared The symptoms of closed vascular injury such as open vessel injury or insufficient blood supply, interruption, and blood return to the distal extremity.
Examine
Excision of replanted limbs
The laboratory examination of this disease focuses on the examination of the limbs, the head, chest, abdomen and other parts should be examined in detail to determine whether there are multiple injuries and multiple fractures. Take X-rays if necessary. At the same time, blood routine examination, urine routine examination, and brain CT examination are required. Different laboratory tests, such as blood matching, are performed according to different conditions.
Diagnosis
Diagnosis and identification of replanted limbs
(1). Complete disconnection: the distal part of the limb is completely isolated from the body, without any tissue connection, called complete disconnection.
(2). Most of the disconnection: most of the local tissue of the limb has been broken off, and there are fractures or dislocations. The residual soft tissue is less than 1/4 of the total soft tissue of the section. The main blood vessels are broken or embolized. There is no blood circulation or severe ischemia on the far side. If the blood vessels are not connected, the limbs will be necrotic.
