Thumb Reconstruction with Thumb Nail Flap Transplantation

Suitable for sleeve-like avulsion of the left thumb skin. Treatment of diseases: hand trauma, open hand injury Indication Suitable for sleeve-like avulsion of the left thumb skin. 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 left thumb skin is avulsed. The avulsed skin can no longer be replanted. The indication and middle finger are seriously damaged and cannot be repaired. The thumb toe of the thumb was designed on the ipsilateral toe. The skin of the big toe is preserved to repair the wound on the toe. The design of the lateral toe of the big toe. Back toe side incision. The dorsal iliac vein and the dorsal artery of the first metatarsal are separated. The toe and toe base arteries are separated and ligated to the temporal side of the second toe. Pick up the dorsal part of the flap of the big toe nail. Pick up the lateral flap of the big toe. The fundus of the lateral toe of the big toe is placed in the flap. Free the toe nail flap. Except for the dorsal metatarsal artery and the dorsal iliac vein, the rest of the tissues have been disconnected. The injured hand showed that the middle finger was cut off and the wound was directly sutured. The proximal thumb is used to find the main artery of the thumb, the ulnar side of the finger and the dorsal vein. The toe nail flap was moved to the recipient area. For the buckwheat wound, the flap of the big toe was covered with the flap preserved on the side of the big toe, and the other wounds were repaired with medium-thickness skin flaps and pressure bandaged. The thumb and phalanx are wrapped around the thumb. Sew the thumb ulnar side of the finger toe nerve. The dorsal vein of the toe and the dorsal artery of the tibia were anastomosed with the dorsal vein of the thumb and the main artery of the thumb, respectively, and the blood circulation of the thumb flap was reconstructed. Reconstruct the lateral view of the thumb. Another case of right thumb sleeve avulsion with the back of the ankle and wrist skin defect. Avoid the skin unconditionally replanted. The same side of the toenail flap was taken with a 15 cm*6 cm foot flap. Find and mark the radial artery and cephalic vein during debridement of the thumb. The ulnar nerve is cut at the distal end and moved into the thumb wound. The flap of the big toe nail was transferred to the recipient area. The distal phalanx of the toe nail flap and the proximal phalanx of the thumb are fixed with a Kirschner wire. The displaced index finger side finger nerve is sewn with the lateral toe nerve of the big toe. The saphenous vein was anastomosed with the cephalic vein, the dorsal artery and the radial artery, and the blood circulation of the toe nail flap was reconstructed. The appearance and function of the thumb were recreated two years after surgery.