shoulder dissection

1. The primary malignant tumor of the limb should be amputated at an early high position. In the early stage of the disease, the lesion is limited to the bone. If there is no distant metastasis, the tumor segment can be resected and the distal limb replanted. 2. Severe infection of the limbs (such as uncontrollable gas gangrene), or suppurative infections that are uncontrollable by drugs and general surgery, complicated by severe sepsis, threatening the life of the patient. Those who are not amputated to save lives should be amputated in time. 3. Serious and extensive injuries to the limbs, those who cannot be repaired or replanted, must perform amputation immediately. 4. Due to arterial thrombosis, thromboangiitis, arteriosclerosis, diabetes and other reasons caused by insufficient blood supply to the limbs, there are obvious necrosis, should be amputated. 5. Congenital multi-finger (toe), can be cut off. 6. Severe deformity of the limb affects the function, while orthopedic surgery can not improve the function. After the amputation, the prosthetic can improve the function, and the amputation can be considered. Treatment of diseases: gas gangrene, shoulder joint tuberculosis Indication 1. The primary malignant tumor of the limb should be amputated at an early high position. In the early stage of the disease, the lesion is limited to the bone. If there is no distant metastasis, the tumor segment can be resected and the distal limb replanted. 2. Severe infection of the limbs (such as uncontrollable gas gangrene), or suppurative infections that are uncontrollable by drugs and general surgery, complicated by severe sepsis, threatening the life of the patient. Those who are not amputated to save lives should be amputated in time. 3. Serious and extensive injuries to the limbs, those who cannot be repaired or replanted, must perform amputation immediately. 4. Due to arterial thrombosis, thromboangiitis, arteriosclerosis, diabetes and other reasons caused by insufficient blood supply to the limbs, there are obvious necrosis, should be amputated. 5. Congenital multi-finger (toe), can be cut off. 6. Severe deformity of the limb affects the function, while orthopedic surgery can not improve the function. After the amputation, the prosthetic can improve the function, and the amputation can be considered. Contraindications There are serious obstacles to the coagulation mechanism. High blood pressure, diabetes, and some bleeding-prone diseases. Preoperative preparation 1. Amputation will bring severe mental and physical trauma to the patient. Therefore, the patient and his relatives should be explained in detail about the necessity of amputation and the problems in the assembly and use of the prosthesis. In the case of an open amputation, it is necessary to state that the amputation must be performed again. 2. Patients who are amputated after an open amputation are best to wait for the wound to heal after surgery; if they are not healed, they should be skin grafted first. 3. Except for those who have necrosis due to insufficient blood supply, all amputations should be placed on the proximal end of the truncated plane to inflate the tourniquet to reduce blood loss and keep the field clear. 4. In general, patients with high amputees should be prepared for blood transfusion before surgery to prevent shock. 5. Various special circumstances, such as diabetes, malignant tumors, etc., should be controlled with insulin or anti-tumor drugs before and after surgery. Surgical procedure 1. Position: The patient is supine, with a sandbag under the shoulder and hip of the operation side, so that the patient's torso and the operating table are at an angle of 45°. The patient's face turns to the healthy side, so that the shoulder of the operation side is fully exposed. 2. Forming the flap: starting from the scapula condyle, descending along the anterior edge of the deltoid muscle, the arc of the deltoid muscle is curved backward, and then along the posterior edge of the deltoid muscle, to the apex of the axillary fold. After abducting the diseased limb, the proximal end of the incision of the anterior and posterior margin of the deltoid muscle is connected along the axillary fossa. 3. Cut the blood vessels and nerves: cut the skin, subcutaneous tissue and fascia. The cephalic vein is located before the anterior edge of the deltoid muscle and is ligated and cut, and then the pectoralis major muscle is cut at the stop point of the humerus, and the muscle is pulled to the inner side. The medial tendon of the diaphragm and the biceps short head is bluntly separated and the neurovascular bundle is exposed, and the agitation, vein, median nerve and musculocutaneous nerve are routinely cut and treated. Pull the proximal part of the blood vessel and nerve to the lower part of the pectoralis minor muscle, and then cut off the long and short head of the diaphragm and biceps. 4. Cut off the external rotation muscle group: Separate the deltoid muscle, cut it at its stop point, and flip it up to reveal the shoulder joint. The upper arm is extremely rotated internally, and the long head of the triceps muscle is cut off at the beginning of the muscle, and the stop point of the external rotation muscle group such as the small round muscle, the infraspinatus muscle, the supraspinatus muscle, and the posterior joint capsule are cut. 5. Cut off the adductor muscle group: the upper arm is extremely externally rotated, the latissimus dorsi and the great round muscle are cut at the muscle stop point, and the lateral head and the anterior joint capsule of the triceps are cut off, and the diseased limb can be cut off. 6. Stitching: The cut muscles are filled into the shoulder blades and sutured to each other. After the deltoid muscle is turned down, the incision is made to the incision. If the shoulder is over-exposed, the shoulder should be removed and the deltoid muscle should be sutured under the shoulder. The fascia and skin were sutured intermittently, and a negative pressure drainage tube was placed under the incision. complication 1. Hemorrhage and hematoma formation Major bleeding caused by large blood vessel ligation is rare, but it should be highly vigilant. A rubber tube tourniquet was prepared at the regular bedside after surgery. Closely observe the bleeding of the dressing. Once a major bleeding is found, stop the blood band immediately and stop the operation in an emergency. 2. Phantom limb pain The patient often feels that the removed limb is still present after surgery, and has a sense of acupuncture and numbness. This phantom limb sensation can gradually disappear and does not affect the wearing of the prosthesis. However, a few have severe phantom limb pain, which is manifested by the unbearable pain of the entire phantom limb, which persists, especially at night, and its pathogenesis is still unclear. Therefore, the lack of effective treatment methods can take acupuncture, physiotherapy and psychotherapy. Procaine closure or sympathectomy is also feasible.