Ligamentum Fibroma - Forearm Amputation

Amputation is divided into small amputation and large amputation. According to the definition of amputation of Jia Chunbao Diabetic Foot Research Institute: small amputation is to remove the infected and necrotic tissue, and refers to the open partial amputation by partial revascularization or limb correction, and limitedly remove some tissues. Large amputations are due to the inability to reduce severe disease states through vascular reconstruction, drug control, or small amputations. Large amputations are divided into low amputation and high amputation. Low amputation is usually amputated from 10 cm below the knee, while high amputation requires amputation from the thigh root. According to the clinical report of Jia Chunbao Diabetes Research Institute, patients with high amputation have a mortality rate of more than 50% within two years and a mortality rate of more than 80% within 5 years. Treatment of diseases: gas gangrene, thromboangiitis, arteriosclerosis 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 Pay attention to aseptic operation during operation, reduce the chance of infection, and complete the release of the tendon block with as few cuts as possible, completely loosen the adhesion between the tendon and the tendon sheath without causing unnecessary damage to the tendon and surrounding tissues. The secondary damage. 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. The back of the hand is raised near the wrist, hard and tough, the boundary is unclear, and the fixed can not move. Diagnosed as recurrence of ligament fibroma. 2, the wrist of the wrist as an "S"-shaped incision, exploration, see the base of the palm, the tumor has been wrapped around the flexor tendon, the median nerve, and there is no obvious dividing line with the surrounding tissue. 3, the back of the wrist as an "S"-shaped incision, exploration, see the extension of the tendon, wrist and distal radius of the tibia have been invaded by the tumor. 4, explore the II, IV metacarpal space, see the interphalangeal tissue is also inseparable from the tumor. 5, the central area of the lesion, fibrous cells are rich, fat, with mild pleomorphism. The lesion is composed of abundant fibers and elongated spindle cells, and the spindle cells have no obvious polymorphism (HE*40). 6, because the tumor can not be removed, so the forearm distal 1/3 amputation. complication First, the stump bleeding. Second, stump pain. Third, stump infection. Fourth, phantom limb pain.