Emergency thumb defect reconstruction

The thumb function accounts for more than half of the full-hand function. After the loss, it seriously affects the pinch, grip, and grasp function of the hand. On the contrary, the thumb is healthy, and the other four fingers are completely or partially missing, and the same obstacle is also encountered. Therefore, rebuilding a thumb or other four fingers is a necessity. Emergency thumb reconstruction can reduce the number of operations, shorten the course of treatment, and restore function quickly. The anatomy is clear and the operation is easier. The hammer was bruised and the double thumb was completely defeated. Treatment of diseases: thumb metacarpophalangeal joint ulnar collateral ligament injury thumb reconstruction Indication Suitable for left thumb defect. Preoperative preparation 1. Establish a good relationship between nurses and patients. Respect each other and trust each other. 2. Adjusting the support system After the patient is hospitalized, there will always be some worries such as worrying about the economic burden, worrying about the work problem, worrying about how others see their own re-creating fingers, etc. The nursing staff should try their best to get the encouragement and support from the family and friends 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. Using Cognitive Therapy Cognitive therapy is through the communication between the nurse and the patient. The common sense of the patient's understanding of the meaning of the conversation through the communication is to answer the patient's various concerns and let him re-understand and let him put down his mind. Various burdens. Surgical procedure Take the second toe of the two feet and reconstruct the bilateral thumb. The surgical procedure is the same as the elective surgery. The dorsal artery of the first metatarsal of the right foot is of type I. The first metatarsal artery of the left foot is also type I. Two years after surgery, the thumb is re-created. Double thumb abduction function. In another case, electric shaving caused a ulnar half defect in the right thumb. Damage to the dorsal view of the thumb. Side view of the injured finger. Transplantation of the metatarsal tibial flap of the distal phalanx of the distal part of the design of the proximal toe. The thumb toe side incision. The toe dorsal vein, the base of the metatarsal toe and the nerve are exposed at the base of the toe. When the thumb is debrided, find and mark the dorsal vein, the thumb ulnar artery, and the finger nerve. Part of the toe nail of the big toe has been cut and moved to the recipient area. The distal toe phalanx is cross-fixed with a Kirschner wire. Sewing the toe finger nerve. The aortic and toe-finger veins were ablated to reconstruct the blood circulation of the transplanted part of the big toe. Repair the dorsal view of the thumb. In another case, male, 9 years old, the left thumb is not completely broken due to the squeeze. Six days after debridement and suturing in a hospital, he came to the hospital for skin necrosis due to injured thumb and big fish. Intravenous infusion of antibiotics after admission. After 3 days, the thumb was rebuilt. A second toe transplant with the rudder-like flap on the same side was taken. The dorsal vein of the dorsal vein and the saphenous vein of the dorsal vein of the foot were exposed and separated. The dorsal artery of the foot, the dorsal artery of the first metatarsal, the base of the toe and the long extensor tendon of the toe and the long flexor tendon of the toe were separated. The second toe with the rudder flap is removed from the metatarsophalangeal joint. Except for the dorsal artery and the saphenous vein, the rest of the tissue has been disconnected. The proximal phalanx of the thumb is intercepted at the base. Marked on both sides of the nerve, thumb extension, flexor tendon. The radial artery and cephalic vein were separated at the anesthesia. The vascular pedicle of the second toe was cut and transplanted to the receiving area. A single K-wire obliquely fixed toe phalanx, sutured the periosteum. Stitch flexion and extension of the tendon. Sew the fingers and toe nerves. Anaesthesis of the dorsal artery and radial artery, saphenous vein and cephalic vein. Rebuild the blood circulation of the transplanted toes. Trim the flap and rebuild the thumb. 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, 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.