Anatomical features of fingers

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 living as much as possible, sometimes special replanting methods are adopted, such as: simultaneous disconnection of multiple limbs, in order to obtain better Function, according to the specific injury, the replantation of the broken limb replacement position, which is called limb displacement replantation, in order to eliminate the replanted limb defect blood vessels, cut the other minor parts of the unknown blood vessel recommended transplant to solve Hard, wait. Treatment of diseases: hand muscle tendon injury and finger replantation 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. Vein: Located on the back of the finger, it is in the form of a net. It is dispersed to concentrated, dispersed, and concentrated. The index refers to the hemiplegic side, and the ring and the little finger are on the side of the ulnar side. 2. The distal vein of the finger merges from the sides of the nail edge to the back of the finger, and combines 1 to 2 branches near the distal interphalangeal joint, with a diameter of 0.5-0.7 mm. Divided into 4 types. 3, there are 1 to 3 volar veins, the diameter is 0.3 ~ 0.6mm, the wall is thin, located under the dermis, divided into 5 types. 4, arteries and nerves: located on both sides of the flexor tendon sheath. The artery is on the outer dorsal side of the nerve. 5, both sides of the arterial artery to the end of the base to send extra branches, the central convergence of the arch artery, diameter 0.4 ~ 0.6mm, and then branch to the finger end. The middle branch of the last section is thicker, which is conducive to the anastomosis. 6, repair refers to superficial flexor tendon, long flexor tendon. Anastomosis refers to the total nerve. Anastomosis refers to the common artery. Reconstruct the blood circulation of the palm. 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, life-threatening, but also cause vasospasm and thrombosis of replanted limbs due to contraction of peripheral blood vessels, leading to 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: a patient who has a long-term shock, or a long-term ischemic limb ischemia, has a tissue degeneration, or has a high plane of the broken limb and has a large number of muscle injuries. 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 preventing infection of the broken limb is a thorough debridement. Prophylactic antibiotics should continue throughout the body after replantation.