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

Suitable for the injury caused by the left thumb III degree defect. Treating diseases: thumb reconstruction Indication Suitable for the injury caused by the left 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 1. The injury caused a III degree defect in the left thumb. Show, little finger is missing. The thumb is curled and contracted. The middle and the ring refer to the dry necrosis of the stump. 2. The second toe transplantation incision was designed in the right foot with the dorsal artery of the foot and the saphenous vein as the vascular pedicle. 3. According to the area of the thumb of the healthy side, the forearm flap with the radial artery and the cephalic vein as the vascular pedicle was designed on the volar side of the right forearm to repair the left thumb. 4. The second toe with the dorsal artery of the foot and the saphenous vein as the vascular pedicle was taken as described above. The second toe is completely free except for the vascular pedicles. 5. Cut the forearm flap pedicled with the radial artery and cephalic vein. 6, remove the thumb stump bone scar. Fully release the first and second metacarpal space to open the thumb. Separation of the thumb and the flexor tendon on both sides of the nerve. Bite off the hardened bone ends. Anatomy of the snuff pocket for transverse incision, separation of the cephalic vein and radial artery. The forearm flap was moved to the receiving area. The donor skin is repaired with a medium-thickness skin. 7. The forearm flap was transplanted into the defect area of the thumb and skin, and fixed with a number of needles in the affected area. The radial artery and the proximal end of the cephalic vein on the flap pass through the subcutaneous tunnel and are anastomosed to the radial artery and cephalic vein of the forearm. 8. The second toe is moved to the stump of the thumb, and the bone end is repaired and fixed internally. Long toe, flexor tendon and thumb length extension, flexor tendon suture. Sew the bilateral toe fingers. The dorsal artery and saphenous vein were respectively anastomosed with the radial artery and cephalic vein in the flap, and the blood circulation of the thumb was reconstructed by vascular tandem anastomosis. 9. Rebuild the thumb extension function after two years. complication Nursing intervention to ensure the patient's good coordination has been in an emergency state, and the postoperative position is forced, which can easily lead to anxiety and sleep disorder. At the same time, reconstruction refers to a high risk of surgery, a failure or complications. Patients are often difficult to accept, so nurses should do postoperative health education. Inform the patient that the postoperative ward is absolutely non-smoking, because the cigarette contains nicotine, which 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 change the position, such as turning over, sitting up , get out of bed, etc. Will seriously affect the re-creation of the blood circulation, induce vascular crisis, a variety of adverse stimuli and emotional instability, are likely to lead to vascular crisis.