Upper arm amputation and replantation

Replantation of the broken limb is the re-entry of the limb left and right, and the limb is regained blood for survival. A limb that is interrupted by trauma or Sunday surgery, causing most or all of the tissue to be broken is called a broken limb. The limb of the broken limb has poor blood supply, or no blood supply. If the limb is not replanted, it will be necrotic. Broken limbs include: large limb disconnection and finger, toe, or part of the finger, the toe of the toe, the surgical conviction method used for replantation of the broken limb to anastomosed blood vessels including arteries, veins to keep the limbs bloody and live. It also includes the repair or (and) internal fixation of bones and joints, as well as the repair of nerves, muscles, tendons, skin and other tissues. The limb amputation is a serious limb injury this year. In order to ensure the survival of the limb and to take care of the function of the surviving as much as possible, sometimes special replanting methods are adopted, such as: simultaneous disconnection of multiple limbs, in order to obtain better The function can replant the position of the broken limb according to the specific injury. This is called limb displacement and replantation. In order to eliminate the replanted limbs, the secondary vessels are recommended to be transplanted. Solving is difficult and so on. Treatment of diseases: replantation of severed fingers Indication 1. The patient's general condition allows, can be replanted. 2. There is a certain degree of completeness from the limbs: cutting or sawing off limbs, neat wounds, slight damage to blood vessels and soft tissues. 3. There is a time limit for replanting: it is generally considered to be 7 to 8 hours at normal temperature. Properly preserved in the cold season or off the limb. 4. Refers to the broken finger at the root, or the broken finger with a greater influence on the function of the opponent. 5. For multiple broken fingers, first replant the fingers with the main function, or replant all. Contraindications 1. Suffering from systemic diseases, poor physical condition, or complicated with serious organ damage, it is not allowed to replant for a long time. 2. Broken finger with multiple fractures or severe soft tissue injury. 3. The integrity of the integrity of the finger vascular bed is severe. If the finger is broken by the crush injury, it is manifested as subcutaneous blood stasis on both sides of the finger. Even if the blood vessel is turned on, the soft tissue is extensively oozing, and the thrombus is replanted, and the finger is still difficult to survive. 4. If the replantation time limit is excessively exceeded and the tissue has undergone degeneration, it is not suitable for replantation. If it is not refrigerated, the finger can still replant after 24 hours of ischemia. If it is injured, it will be refrigerated and the time limit for replanting can be extended to more than 30 hours. However, the shorter the ischemic time, the higher the replantation survival rate, and the longer the ischemia time, the lower the replantation survival rate. Preoperative preparation 1. Actively prevent and treat shock, timely and adequate blood transfusion, and supplement blood volume. 2. The isolated limbs are aseptically processed and stored in a refrigerator at 2 to 4 °C. 3. Prepare appropriate fracture fixation equipment according to the site of the limb. 4. Prepare surgical microscopes and microsurgical instruments. Surgical procedure 1. The limbs that have been removed are brushed, disinfected, and laid, and the sections are dried by soaking with 0.1% benzalkonium bromide. The radial artery, iliac vein, cephalic vein, expensive vein, median nerve, ulnar nerve and radial nerve were found and marked in the wound. Remove damaged and contaminated tissue from wounds. It was further washed with 3% hydrogen peroxide solution and 0.1% benzalkonium bromide solution. Finally, it was washed twice with physiological saline. 2. Under the control of adequate anesthesia and tourniquet, the proximal wound is treated according to the distal treatment method and procedure. 3, bone stent reconstruction, fast, simple, fixed and reliable principle. The specific method is selected according to the situation. Intramedullary nail fixation. 4. The two fracture ends are stepped and fixed with screws. 5, Kirschner wire cross fixed. 6, steel plate screws fixed. 7. Before repairing nerves and blood vessels, repair the diaphragm, diaphragm and triceps to establish a soft tissue vascular bed. The anastomosis of the radial artery and accompanying veins, cephalic veins, and expensive veins were performed under a surgical microscope. Suture the median nerve, ulnar nerve, and phrenic nerve. After the limbs are reconstructed, the biceps muscle is repaired. 8. The upper arm is replanted and the skin is sutured without difficulty after the bone is shortened. If there is a slight skin defect, local flap transfer and skin grafting can be used to close the wound. Isolation of the limbs for more than 8 hours, after replantation to prevent high pressure in the fascial space, can be performed under the fascia in the volar forearm. complication 1. Insufficient blood volume: The main cause of insufficient blood volume in patients with broken limbs is blood loss. Reduced blood volume can not only cause shock, but also life-threatening. Moreover, due to contraction of peripheral blood vessels, vasospasm and thrombosis of the replanted limbs may occur, resulting in failure of replantation. Therefore, the pulse, blood pressure, urine volume, jugular vein filling, skin temperature, color and capillary filling time of the broken finger (toe) should be closely observed after the operation. If the systolic blood pressure is above 14.22 kPa (100 mmHg) and the urine volume is >30 ml, the external jugular vein can be seen on the clavicle. The broken finger (toe) is rosy and warm, and the capillary filling time is less than 2 seconds, indicating that the blood volume is normal. If there is insufficient blood volume, the treatment is mainly infusion and blood transfusion, supplement blood volume, avoid applying pressure-boosting drugs, especially norepinephrine, so as not to cause strong contraction of blood vessels, resulting in anastomotic thrombosis. 2, acute renal failure: for patients with long-term shock, or limb ischemia for a long time, with tissue degeneration, or higher limb plane, a large number of patients with muscle damage. After revascularization of the limbs, special attention should be paid to the occurrence of acute renal failure (expressed as oliguria, urinary retention, hemoglobinuria, low urine specific gravity, elevated blood urea nitrogen, increased blood potassium, etc.). This complication should focus on prevention; such as timely correction of shock, strict control of the indications for replantation of the broken limb, thorough debridement, removal of all inactivated muscles, incision of fascia decompression, and appropriate postoperative infusion, static point rate Urine, accelerates the excretion of toxic substances to prevent the occurrence of acute renal failure. Once it occurs, it should be actively treated, such as limiting the amount of intake, controlling hyperkalemia, correcting acidosis and azotemia. If there is no improvement, if you continue to retain the broken limb and will endanger the patient's life, you should get rid of the replanted limb as soon as possible. 3, prevention of infection: As mentioned above, the key to prevention of broken limb (referring to) infection is thorough debridement. Prophylactic antibiotics should continue throughout the body after replantation.