Composite tissue graft thumb reconstruction (parallel anastomosis of blood vessels)

Suitable for injury to the right thumb III degree defect. Treatment of diseases: congenital and refers to multi-finger malformation and refers to deformed multi-finger malformations Indication Suitable for injury to the right thumb III degree defect. Contraindications Avoid smoking, alcohol and spicy food, diet is based on high-nutrient and digestible foods, eat more fresh vegetables, fruits, drink plenty of water, keep the stool smooth. Preoperative preparation 1. Establish a good relationship between nurses and patients. Respect each other and trust each other. 2, adjustment support system patients often have some worries after hospitalization, such as worry about the economic burden, worry about work problems, worry about how others see their own re-creation of fingers and other caregivers should try to get the encouragement and support of family members and colleagues to receive treatment. 3. Creating a good environment for a good medical environment is important for normal people. It is more important for patients. A quiet and clean environment is conducive to calming the patient's mood. Watching TV, listening to music, walking outdoors and other activities can distract the patient's attention and reduce the patient's psychological burden. 4, the use of cognitive therapy cognitive therapy is through the interaction between the nurse and the patient through the communication to make the patient understand the meaning of the conversation related to the common sense of the patient to answer the various concerns of the patient to re-recognize it to let go of the mind Various burdens. Surgical procedure The injury resulted in a right thumb III degree defect, a thumb cramp and a large fish scar contracture. The back of the hand is on the side. Suffering from the palm of your hand. The same side second toe was used to reconstruct the thumb. Design a rudder-like flap on the back of the foot to prepare for the repair of the thumb. The lateral foot flap with vascular pedicle as the terminal branch of the radial artery was designed in the contralateral ankle. The flap is lifted, and the flap includes the terminal branch of the radial artery and the small saphenous vein. Pick up the rudder-like foot flap. The second toe was dissected as described above. Except for the dorsal artery of the foot and the stenosis of the saphenous vein, the rest of the tissue has been disconnected. Remove the thumb and the big fish scar. Separate and open the first and second metacarpal space; relax the long thumb, flexor tendon and bilateral finger nerves; dissect the nasal incision for transverse incision, dissect the radial artery and cephalic vein. The vascular pedicle of the second toe and the lateral foot flap was cut and transplanted into the recipient area. The lateral lateral wound was repaired with a medium-thickness skin flap and pressure bandaged. The toe and phalanx were trimmed, and the periosteum was fixed and sutured with a single Kirschner wire; the flexor tendon was stretched and the tendon was adjusted to adjust the tendon tension so that the reconstructed thumb was in a resting position. Sew the fingers and toe nerves. The lateral flaps were placed in the first and second metacarpal spaces to reconstruct the thumb. The radial branch and the small saphenous vein were anastomosed with the deep plantar branch of the dorsal artery and the saphenous vein branch. The small saphenous vein is anastomosed to the great saphenous vein. The terminal branch of the radial artery was anastomosed to the deep branch of the dorsal artery. The dorsal artery and the saphenous vein were passed through the subcutaneous tunnel. The end of the radial artery and the cephalic vein were respectively anastomosed at the anesthesia. Reconstruct the blood circulation of the transplanted toe and lateral foot flaps. The blood vessels are connected in parallel. Trim the flap, close the wound, complete the thumb reconstruction and thumb reconstruction. Reconstruct the thumb and side view. The raised skin is to be trimmed later. complication Nursing intervention to ensure that the patient is well coordinated with the patient has been in an emergency state, and the postoperative position is forced, which can easily lead to anxiety and sleep pattern disorder. At the same time, reengineering means that the risk of surgery is very high. If a failure or complications occur, the patient is often difficult to accept, so the nurse should do a good job in post-operative health education. Inform the patient that the postoperative ward is absolutely non-smoking. Because the cigarette contains nicotine, it is easy to cause vasospasm, prevent active and passive smoking: ensure that the local temperature of the lamp is constant, can not change the lamp distance, and greatly change the position, such as turning over, sitting up, getting out of bed, etc., will seriously affect the reconstruction Refers to the blood circulation, induced vascular crisis, various adverse stimuli and emotional instability, are likely to lead to vascular crisis.