Reconstruction of thumb extension function with tendon transposition

It is suitable for the old cut of the back of the first metacarpal of the right hand, and the thumb cannot actively extend straight. Anatomical studies have found that in the total extensor tendon, the muscle abdomen of the index finger is relatively independent, and the tendon starting position of the middle finger is higher. Conclusion The indication of the intrinsic extensor tendon displacement and reconstruction of the thumb function can obtain better thumb function in the case of appropriate indications, and has little effect on the function of the index finger. It refers to the independent differentiation of the extensor muscles of the extensor tendon in the total extensor tendon, and the function of independent indexing can be completed after removing the intrinsic extensor tendon. Treatment of diseases: open hand injury to hand tendon injury Indication It is suitable for the old cut of the back of the first metacarpal of the right hand, and the thumb cannot actively extend straight. Contraindications 1. The infection after the local injury has not been eliminated. 2. Injury refers to the passive flexion and extension of each joint. Preoperative preparation After a group or a muscle is paralyzed, the balance of muscle strength is imbalanced, which will inevitably cause deformity and a series of functional and structural changes after malformation. Therefore, detailed examination, careful analysis, and necessary preparations are required before surgery: 1. The number and degree of muscle spasm vary, due to the length of the date, the influence of gravity, the amount of use and the weight of the deformed foot can cause different deformities. Almost every patient's deformity has its own particularity, and even the same muscle tendon can often cause different deformities. Therefore, it is necessary to conduct a detailed examination and thorough understanding of the deformity, muscle spasm, and muscle strength of the abscess before surgery, and fully estimate whether a new imbalance will occur after the transfer, and a new malformation will occur. In this way, the surgical design can be tailored to the patient's specific situation and the expected results are achieved. Otherwise, it is very likely that the original deformity has not been corrected, but instead caused another deformity. 2. All soft tissue contracture deformities and deformities of the bone structure must be corrected before the metastasis, or corrected before surgery. It is not in principle and impossible to correct these deformities by relying on muscle strength after tendon transfer. Only after the deformity is corrected can the transferred muscle maintain the corrected condition and prevent the recurrence of the deformity. 3. After the muscle is paralyzed, the balance of muscle strength is imbalanced, and the limb function is affected to some extent, so that the muscles of the attempted atrophy will also shrink to varying degrees, the muscle strength will be correspondingly weakened, and the joint activity will be limited. Therefore, exercise should be strengthened before surgery, supplemented by physical therapy, etc., so that the function can be restored as much as possible, and the muscle strength reaches 4 to 5 to ensure the effect of surgery. 4. Prepare a sufficient range of skin as usual on the 2nd day before surgery. After the deformity of the foot, it often occurs in the weight-bearing part. Before the operation, it is necessary to soak the feet with warm water to make the skin soft and clean, in order to facilitate surgery. Surgical procedure Make a small curved incision at the original wound to reveal the distal end of the extensor digitorum longus. The broken ends are neat and non-adhesive. The proximal end has been retracted to the wrist. It was decided to reconstruct the thumb function by shifting the intrinsic extensor tendon of the index finger. According to the end of the thumb extensor tendon, the length of the donor is measured. A small transverse incision is made on the skin of the appropriate part of the extensor tendon, and the tendon is picked up. The ruler is the intrinsic extensor tendon. Cut off the sputum and sneak off to the near side. The intrinsic extensor tendon is extracted from a small transverse incision in the distal edge of the transverse ligament of the wrist. The distal end of the intrinsic extensor tendon and the total extensor tendon of the index are made into the suture. The subcutaneous tunnel introduces the intrinsic extensor tendon into the dorsal incision of the first metacarpal, and is fixed by the needle across the tendon to avoid retraction. Adjust the distal and distal tension of the tendon, and use the 3/0 non-invasive needle thread to make the double "8" word end-to-end suture. Close each incision. The plaster brakes the thumb and wrist over the extension for 4 weeks. complication Suppurative infection, infected wounds have pain, redness, tenderness, purulent secretions, etc., body temperature can be increased and neutrophils can be increased. Closed wounds may also be associated with various infections, such as post-injury aspiration, airway endocrine retention, and atelectasis secondary lung infections. Tetanus or gas gangrene may also occur after the injury, and the consequences are quite serious.