Text, photo/Jiang Xin, correspondent of Zheng Da, an all-media reporter of the Yangcheng Evening News
A half month ago, Mr. Shi from Zhuhai accidentally crushed his right hand by a baler while working, causing severe pain and bleeding. After being bandaged in another hospital, he was transferred to the Fifth Hospital of CUHK for treatment. The doctor found that his right palm was seriously injured and the skin of his right thumb was detached. After an emergency operation, Mr. Shi’s bloody right hand was finally repaired initially, but his thumb If the skin is severely damaged and the bones are exposed, if it is not repaired in time, the shape and function of the hand will be seriously affected, and the phalanx will be further necrotic.
Postoperative thumb reconstruction completely survived. Photo courtesy of respondents
Without thumb, 40% of The hand function will be lost, and his daily activities such as work, eating, and writing will be greatly affected in the future. Mr. Shi has higher requirements on the function and aesthetics of his right hand due to work reasons.
After detailed discussion, the surgical team of Cai Xiyu, deputy director of the trauma and joint surgery department of the Fifth Hospital of CUHK, finally decided to perform the right foot toenail flap reconstruction operation for the patient, that is, the skin and toenail of the first toe of the right foot were taken. Including nerves and blood vessels, transplanted to the hand for corresponding vascular and nerve anastomosis, reconstruction of blood supply, and restoration of the appearance and function of the right thumb.
Subsequently, the surgical team performed a nearly 7-hour operation, including debridement, incision of the toenail flap of the right foot, and transplantation to the right thumb. In the process of cutting the toenail flap of the right foot, it is necessary to be very careful to protect the blood vessels and nerves that supply blood; and the process of anastomosis needs to be carried out under an operating microscope. The blood vessels and nerves are sutured correspondingly. With the joint efforts of the trauma and joint surgery medical team, the thumb was completely survived after 7 days.
It is reported that fractures and dislocations caused by severe trauma can be reduced and fixed, while the complete amputation of limbs will cause limb necrosis and amputation due to loss of blood circulation. The operation of reconnecting a completely severed limb is called “replantation of a severed limb (finger)”. This operation requires, on the basis of thorough debridement, to fix fractures, suture muscles and tendons, anastomose blood vessels and nerves, and suture skin and skin defects. When it is necessary to perform skin grafting or skin flap transfer coverage. Replantation surgery is best performed within 6-8 hours after injury, with a certain time limit.
If the severed limb is complete and can be replanted with the severed finger, what should I do if the severed part has been damaged, that is, the severed part is missing and rotten? Reconstruction can be performed using microsurgical techniques.
Most of the reconstruction is for the thumb and fingers. If the fingers are missing, various methods can be used for reconstruction, such as bone grafting and skin flaps, finger lengthening, finger transposition, and toe transplantation Wait for the fingers to be recreated. Among them, toe transplantation to reconstruct fingers is a classic operation of microsurgery, which requires skilled vascular and nerve suture techniques.
In addition, limb tissue and function are lost and require reconstruction. For example, the application of vascular anastomotic fibula transplantation in the treatment of femoral head necrosis in young and middle-aged people, the treatment of complex and significantly displaced femoral neck fractures, and the reconstruction of femoral head and neck tumors after curettage have good curative effects. The Department of Trauma and Joint Surgery of the Fifth Hospital of CUHK has developed surgical instruments and improved surgical techniques in recent years, combining microsurgical techniques with Ilizarov techniques to treat nonunion, bone defect, osteomyelitis, and fracture malunion. Good results have also been achieved. Effect.