对断肢指的再植手术

对断肢指的再植手术History陈中伟：王存柏病例InJanuarysecond,1963，MachinecutJanuary,coldweatherAmputatedpartwrappedintowelReachhospitalwithin1hourBut,thistime…..WorldFirstHandReplantationDoyoulikethislesson?DoyouwanttobeasurgeonasChenZhongwei?LearningOutlineDefinitionandHistory定义和历史Classification分类Anatomy解剖Amputatedpartsstorageandtransportation断指的保存和早期处理Indications

适应症Surgicaltechniqueinsequence再植手术顺序Post-operativecare

术后处理 DefinitionThesurgicalreattachmentofalimb/digit,thathasbeencompletelycutfromaperson'sbody,restorethebloodcirculation,sothatlimb/digittogetthesurvivalandrecovery.将完全离断的四肢/手指重新接上，恢复其血液循环，使断肢/指得到存活和恢复功能的手术。Höfner 1903 AnimalsurvivalJacobson&Suarez 1960 Smallvessel屠开元 1960 DogReplantationMalt 1962.5Arm陈中伟 1963.1 HandKomatsu&Tamai 1965 Fingers陈中伟 1966 FingersHistoryClasscificationregularcut

andRingAvulsionFingertipamputationAnatomyAftersurgeryGoodboneunionRingAvulsionAmputation脱套伤AftersurgeryClasscification:

oneormultiplefingers

Pre-OPLaterpost-OPPost-OPClasscification:ForearmamputationPre-OPLaterpost-OPClasscification:UpperarmamputationPre-OPPost-OPLaterpost-OPAnatomyofDigitsThefingersaresuppliedbyvesselsandnerveswhichrunupthelateralaspectsofeachdigit.Howtoaccomplishareplantation?

怎样完成断肢/指再植？

通过以下四个问题学习

QuestiononeAfteraccidence,whatshouldwedo?StorageandtransportationStep1:

Puttheamputatedpartintoaplasticbag.Step2:

Putawater-tightknotatthetop.Step3:

PlacetheplasticbagwiththefingerintoathermocolboxfilledwithiceDONOT-Putthepartandicecubestogetherinthesamebag.DONOT-Puttheamputatedpartintoanysolutionlikewater,glucoseorformalin.DONOTQuestionTwo:Whatkindofamputateddigits/limbscouldbereplanted?Indications适应证全身情况良好断肢/指条件，断肢/指部位、个数再植时限：肢6-8小时，指12-24小时年龄、性别IndicationsindetailMostfavorableindicationsAmputationofthefingeratalocationproximaltotheIPjoint（Interphalangeal指间关节）Amputationof3ormorefingersChildrenRelativelyfavorableindicationsAmputationofthefingeratalocationdistaltotheIPjointAmputationof2fingersWomenNoindicationsFingersthatwouldbecomesignificantlyshortenedQuestionThree:Whatisthesequencewhenreplantthedigits/limbs?SurgicalTechniqueinsequenceDebridement清创术ShortenandFixBone(Kwires

or

screws);

Repairthe

ExtensorTendons伸肌腱;Repairthe

FlexorTendons屈肌腱;Anastomose吻合Arteries;

AnastomoseVeins;RepairNerves；Closeincision.Procedure1:Debridement清创Afterregionalanesthesia麻醉orgeneralanesthesia,removedead,contaminated,oradherenttissueand/orforeignmaterial.

Findthevessels,nerves…Procedure2:boneandtendon

Shortenthebonetoeliminatetensionontherepairedvessels.FixBonewithwires

or

screws.Repairthetendon.Procedure3:nerveandvessels

Anastomose吻合nervesandvesselswithmicrosurgicalinstruments.Thispartofthesurgeryismostcriticaltoitssuccess.Theskinisthenclosed.MicrosurgicalEquipmentQuestionFour:Whatshouldwedoafterreplantationoperation?Plaster（石膏）shouldNOTrestrictperfusion（血液灌注）ThereplantedpartshouldbereadilyobservedtoassessperfusionMonitoringdevicescanbeusedtoassessperfusionPost-operativeCarePost-opCareClinicalColorCapillaryrefillTemperatureBleedingTurgor充盈DopplerSurfaceImplantableAftercare-HandRehabilitationThefunctionofthereplanteddigitvariesdependingonthetypeofinjury,thequalityoftherepair,andthepost-operativehealingcourse.Physicaltherapyaftersurgeryisrequiredtooptimizefunction.AftercareInfectionTendonadhesionsJointstiffnessMalunion

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