Replantation Of Severed Fingers Research Articles

Clinical efficacy of enhanced recovery after surgery nursing in patients with multiple severed fingers replantation

Objective To study the clinical efficacy of enhanced recovery after surgery nursing in patients with multiple severed fingers replantation. Methods From December 2016 to June 2018, 90 patients (232 fingers) with replantation of severed fingers were divided into experimental group and control group, 45 cases in each group. The experimental group was given enhanced recovery after surgery nursing and the control group was given routine nursing. The complications such as embolism and necrosis of replanted fingers in the two groups were analyzed, and nursing satisfaction was compared. Results The incidence of complications in the experimental group was 4.44%, which was lower than that in the control group of 17.78% with the difference being significant (P<0.05). The nursing satisfaction of the experimental group was 97.78%, which was higher than that of the control group of 84.44% with the difference being significant (P<0.05). Conclusion After the replantation of severed fingers, the nursing plan of enhanced recovery after surgery was used to intervene the patients, which can significantly reduce the risk of complications, promote the recovery of the condition, improve the prognosis effect, and improve the clinical nursing quality. Key words: Replantation; Postoperative complications; Enhanced recovery after surgery; Nursing care

Clinical application of three kinds of anastomosis methods of digital artery in replantation of degloving amputated thumb and fingers of Urbaniak III type in children

Objective To report the clinical application and efficacy of three kinds of anastomosis methods of digital artery in replantation of degloving amputated thumb and fingers in children. Methods From May 2012 to July 2018, 16 children with 17 fingers of degloving amputated injuries were replanted. According to Hou Ruixing's classification method of finger degloving injury type Ⅲ, the cases were classified intoⅠ degree of 6 fingers,Ⅱ degree of 11 fingers base on different skin avulsion planes. Three kinds of anastomosis methods of digital artery were in situ anastomosis of bilateral digital artery in 7 cases 8 fingers, cross anastomosis of a digital artery in 7 cases 7 fingers and transposition anastomosis of adjacent digital artery in 2 cases 2 fingers. Results The replantation of 17 fingers in 16 cases was successfully completed. The postoperative blood circulation was good. Among them, 7 cases 8 fingers with bilateral digital artery anastomosis survived, 3 cases 3 fingers with cross anastomosis of a digital artery occurred necrosis, and 2 cases 2 fingers with transposition anastomosis of digital artery survived. Thirteen patients with 14 fingers survived were follow-up for 3 to 36 months, with an average of 18 months. The growth of nails was found in all the fingers anastomosed with bilateral phalangeal arteries, including 2 cases of nail growth deformity, 1 case of partial absorption of the distal phalangeal bone leading to the shortening of the distal phalangeal body, while the function of pinching and the skin color and temperature were normal. The growth of nails was found in 4 surviving affected fingers with cross anastomosis of a digital artery, including 2 cases of nail growth deformity, 2 cases of partial absorption of the distal phalangeal bone leading to the shortening of the distal phalangeal body, which did not affect the holding function with slightly poor skin color, low temperature and finger body atrophy. The growth of nails was found in all the fingers with transposition anastomosis of digital artery, including 1 case of nail growth deformity. The finger was shorter and thicker than the healthy side. The flexion and extension of the finger were good. The skin color was normal and the skin temperature was slightly lower. According to the functional evaluation criteria of replantation of severed fingers issued by Hand Surgery Society of Chinese Medical Association, the results were rated as excellent in 7 cases, good in 4 cases and poor in 2 cases. Conclusion For Urbaniak Ⅲ type amputated finger, replantation should be performed as long as the finger body is relatively intact, and the blood supply should be reconstructed by in situ anastomosis of bilateral digital arteries as far as possible. This method has high survival rate and good recovery of finger shape and function after replantation. Key words: Replantation; Treatment outcome; Child; Degloving injury

Analysis of psychological state and its influencing factors after replantation of severed finger

Objective To observe the psychological state of patients after digital replantation and analyze its influencing factors. Methods A total of 80 cases of patients with digital replantation in this hospital from February 2017 to February 2018 were selected as the research objects.The psychosocial status of the patients was assessed by the symptom self-rating scale (SCL-90) at 3 days, 1 month and 3 months after the operation, respectively, and the relationship between the psychosocial status and the patients' age, gender, education level, severity of the disease, social support, self-efficacy and personality characteristics were analyzed. Results The scores of anxiety and horror at 1day after operation were significantly higher than those in norm (P<0.05). The gender, post-injury admission time, warm ischemia time and social support were closely related to the psychological state of patient at 1day after operation (P<0.05). At 1 month after operation, the three dimensions scores of somatization, depression and paranoia were significantly higher than those in norm (P<0.05). Gender, family income, social support and medical coping style were related to psychological state of patients 1 month after surgery (P<0.05). At 3 months after operation, the four dimensions scores of coercion, interpersonal relationship, hostility and paranoia were significantly higher than those in norm (P<0.05). Family income, marital status, social support, Eysenck's personality traits and medical coping style were related to the psychological state of patients at 3 months after operation (P<0.05). Gender was an independent risk factor for patients' psychological state 1 day after surgery and 1 month after surgery.Family income was an independent risk factor for patients' psychological state 1 month after surgery and 3 months after surgery, and social support was an independent risk factor for patients' psychological state at each stage after surgery. Conclusions Patients at different stages after replantation have different psychological problems and their influencing factors are also different, among which social support affects the psychological state of patients at various stages, and intervention can be carried out according to the period and characteristics of patients to improve the survival rate of replantation. Key words: After replantation; Psychological state; Influencing factors

Clinical application of the technology of supercharging and making flap in Yamano area I type II replantation of broken finger

Objective To investigate the clinical efficacy of the use of the technology of supercharging and making flap on Yamano area I type II replantation of broken finger. Methods From January, 2016 to June, 2018, 15 cases (16 fingers) of type II replantation of severed fingers in Yamano area I were treated. During the operation, 2 arteries in the severed fingers were anastomosed and supercharged outside the arteries. Bone fragments in the severed fingers were removed to make them flaps. The blood supply and long-term healing of replanted finger were observed after routine treatment including antiinfection, anticoagulation and antispasm in outpatient follow-up. Results Sixteen fingers of replantation of severed fingers survived smoothly. Followed-up for 6-12 months showed that there were no deformities in the surviving finger, good nail growth, full abdomen and recovery of pain and temperature. The static 2-PD was 7-9 mm. According to the Evaluation Criteria of Replantation Function of Severed Finger of Chinese Medical Association Hand Surgery Society, 13 fingers were excellent and 3 fingers were good. Conclusion In the replantation of Yamano area I type II amputated finger, high survival rate and good healing effect can be achieved by using the technology of supercharging and making flap. Key words: Replantation of broken finger; Yamano I area; Supercharging; Making flap

Application of tendon suture in situ in replantation of avulsed severed finger

Objective To explore the surgical method and clinical efficacy of tendon in situ suture in the replantation of avulsed severed finger. Methods From June 2014 to February 2018, 7 cases of severed finger with tendon pulled out from the abdomen were repaired and replanted by in situ embedding suture through the original tunnel. Results All the wounds achieved primary healing and the replantation of severed fingers was successful. There was no vascular crisis after operation. All the patients were follow-up for 6 to 20 months, with an average of 10 months. The replanted finger has good blood supply, good appearance, full belly, and satisfactory function of flexion, extension and opposition. The two-point discrimination of finger pulp was 8 to 14 mm. According to the evaluation criteria of replantation function of severed fingers issued by Hand Surgery Society of Chinese Medical Association, the results were rated as excellent in 5 fingers, good in 1 finger, and fair in 1 finger. Only linear scars were left on the forearm, and wrist flexion and extension were not limited. Conclusion The tendon of avulsed severed finger can be repaired by suture in situ via the original tunnel. The superficial vein and cutaneous nerve can also be harvested from the same incision of forearm to repair the defect of digital artery and nerve. Satisfactory results can be obtained after operation. Key words: Finger injuries; Replantation; Avulsion; Tendon; In situ suture

Clinical efficacy of finger replantation in the treatment of complete distal segment finger amputations and the analysis of the factors affecting the survival rate of patients with replantation of severed finger

Objective To observe the clinical effect of replantation and non-finger replantation in the treatment of complete distal segment finger amputations, and to analyze the related factors affecting the survival rate of replantation of amputated finger, so as to provide an objective reference for clinical treatment. Methods From March 2015 to June 2016, sixty-two patients with complete distal segment finger amputations treated in the Third People′s Hospital of Huizhou were randomly divided into two groups: the observation group and the control group according to the random number table method.The observation group was treated with finger replantation (Pancreatic repair, orthotopic suture and stump remodeling); the two groups of patients with early finger survival rate, replanting fingernail growth, two points discrimination, distal fingertips The clinical data of 288 patients with replantation of single finger rupture were analyzed retrospectively.The clinical data were divided into two groups: the survivors group, the survivors group 74 cases, compared the clinical data of the two groups of patients, analysis of the impact of replantation of the survival rate of the relevant factors. Results The survival rate of early finger was 8.57% (3/35) in the observation group and 15.15% (5/33) in the control group, the difference was not statistically significant (χ2=0.216, P>0.05). At 6 months after operation, the length of nail growth, the two-point discrimination and the distal interphalangeal mobility were significantly better than those in the control group((13.5±2.9)mmvs.(11.8±2.2)mm); (4.6±0.3)mmvs.(7.5±0.6)mm; (62.5±4.4)°vs.(45.3±3.6)°) (P complete disconnection(OR5.389, 95%CI: 2.672-7.964, P warm ischemic time more than 6 hour(OR4.515, 95%CI: 1.366-8.847, P postoperative section Thrombosis成(OR3.287, 95%CI: 2.543~9.678, P low postoperative skin temperature(OR2.142, 95%CI: 1.243-5.212, P poor postoperative knee elasticity(OR2.008, 95%CI: 1.117-5.449, P<0.001). Conclusion In the treatment of patients with complete injury from the end of the finger, the effect of replantation of the finger is significantly improved, which can improve the postoperative joint activity and improve the appearance and function of the finger.The period of severe depression, complete disconnection and warm ischemia is long Affect the survival rate of finger replantation of the main risk factors for the above factors targeted measures can improve the survival rate of finger replantation. Key words: Finger Replantation; End Finger Amputation; Survival Rate; Clinical Efficacy; Influencing Factors

Effect of auricular seeds pressing on postoperative vascular crisis for patients undergoing replantation of severed fingers

Objective To find ways to reduce vascular crisis of the patients undergoing replantation of severed fingers by pain, adverse analgesics and sleep quality with auricular seeds pressing. Methods 310 digital replantation patients were divided into 2 groups according to admission time. There were 155 cases in the traditional group treated with routine postoperative care ,while 155 cases in the controlled group treated with routine postoperative care plus auricular seeds pressing. Results The scores of pain, adverse analgesics and sleep quality in two groups were statistically significant(P < 0.05). The rate of vascular crisis of the traditional group[18.06%(28/155)]was much more higher than the controlled group[5.16%(8/155)], the difference was significant, χ2=12.571, P < 0.01. Conclusion In digital replantation, auricular seeds pressing was effective to pain relieving, constipation and reduce adverse reactions, and could significantly improve sleeping time and survival rate of the severed fingers. Key words: Auricular seeds pressing; Replantation; Vascular crisis

Therapeutic effects of acupuncture therapy for preventing pain of severed finger replantation

Objective To study the therapeutic effects of acupuncture therapy for prevent pain of replantation of severed finger. Methods Totals of 80 patients were randomly divided into two groups from March 2012 to March 2014. Patients in the treatment group were treated with acupuncture therapy, and patients in the control group were treated with routine care. Results The pain scores of 4, 6, 12, 24 and 48 hours after the treatment in the treatment group were (2.13±0.33), (2.75±0.67), (3.25±0.59), (3.43±0.78) and (2.85±0.62), which were significantly lower than those in the control group (t=2.421, 2.270, 7.223, 7.614, 4.106, respectively; P<0.05). In the treatment group, one case had vascular crisis, with an incidence of 2.5%. In the control group, four cases had vascular crisis, with an incidence of 15.0%, there was a significant difference between the two groups (χ2=2.165, P<0.05). One case in the treatment group had diclofenac sodium suppositories, with an incidence of 2.5%. While seven cases had diclofenac sodium suppositories, with an incidence of 17.5% in the control group, there was a significant difference between the two groups (χ2=2.287, P<0.05). Conclusions Acupuncture therapy can significantly reduce postoperative pain and reduce the incidence of vascular crisis, it is worthy of promotion. Key words: Acupuncture therapy; Pain; Replantation of severed finger

Application of comfort nursing in patients with replantation of severed fingers

Objective To investigate application effect of comfort nursing in patients with plantation of severed fingers.Methods Retrospective analysis was used to investigate influencing factors of comfort for 89 patients with replantation of severed fingers who had received comfort nursing.Self-designed questionnaire,self-rating anxiety scale (SAS) and self-rating depression scale (SDS) were used to compare patients' satisfaction,anxiety and depression before and after comfort care.Results Patients with different gesture,environment,blood circulation of replanted figures,relieving pain and smoking,diet guidance,functional exercise and psychological factors had different degree of comfort (x2 =3.25,4.03,2.25,4.28,3.08,3.75,3.01,respectively; P ＜ 0.05).Multivariate logistic regression analysis showed that patients' comfort was mainly influenced by gesture,blood circulation of replanted figures,environment,relieving pain and smoking,psychological factors,diet guidance and functional exercise (x2 =22.202,5.720,5.234,6.189,7.911,9.019,6.218,respectively; P ＜ 0.05).SAS and SDS scores were (45.38 ± 6.37) and (47.16 ± 5.16)after comfort nursing,lower than (55.82 ± 6.29) and (53.83 ± 7.26) before comfort nursing,and the differences were statistically significant (t =3.735,3.261,respectively; P ＜ 0.05).Patients' satisfaction was 89.89％ before and improved to 98.88％ after,and the difference was statistically significant (x2 =2.946,P ＜ 0.05).Conclusions Comfort nursing mode can effectively reheve patients' psychological pressure,improve patients'degree of satisfaction with nursing,so as to improve the effect of clinical nursing. Key words: Anxiety; Depression; Comfort nursing; Replantation of severed fingers; Influencing factor; Satisfaction

The appfication of two types of flaps in replantation of severed fingers accompanied with skin defect

Objective To summarize the clinical effects of adjacent finger digital artery island flap and venous blood nutrient flap in the replantation of severed fingers accompanied with skin defects.Methods Fifteen fingers in 15 patients accompanied with dorsal,volar or circumferential skin defects were replanted.The skin defects were covered with digital artery island flap for the adjacent finger in 4 cases,venous blood nutrient flap in 9 cases,and with adjacent finger digital artery island flap combined venous blood nutrient flap in 2 cases.Results All 15 replanted fingers and the flaps survived completely.Postoperative vascular crisis occurred in 2 fingers,which was resolved by surgical exploration and intervention.The fingers and flaps were rescued.The patients were follow-up for 1 to 18 months,with an average of 7 months after the replantation.The replanted fingers had no significant shortening.The flaps had good texture and were not bulky.The appearance and function of the replanted fingers were satisfactory.Conclusion The adjacent finger digital artery island flap and venous blood nutrient flap are effective methods to cover skin defects in replantation of severed fingers. Key words: Surgical flaps; Finger injuries; Replantation

Investigation and research in constipation causes of patients undergoing replantation of severed finger

Objective To investigate the factors that induce constipation in bedridden patients undergoing replantation of severed finger and find countermeasures. Methods A retrospective investigation was carried out in 92 patients undergoing replantation of severed finger, their constipation and factors influencing constipation were recorded. Results 61 patients suffered from constipation in total 92 cases,the rate being 66.30%. 76 patients reduced food intake, and 59 cases presented constipation (the rate being 77.63%). Factors influencing constipation included being unaccustomed to defecate in bed (the rate that present with constipation being 87.09%),reluctant to trouble others(75.47%), side effects of drugs(55.56%) and lack of dietary knowledge (71.87%), decreasing food intake was closely bound up with constipation. Conclusions Proper psychological counseling, strengthening of health propaganda, comfortable facility for defecation, improved family support and oral food intake can significantly reduce the proportion of constipation and increase comfort degree of patients. Key words: Replantation of severed finger; Bed ridden; Reduced food intake; Constipation

The nursing and the postoperative observation for 136 patients with replantation of severed finger

目的 探讨断指再植术成功的关键因素.方法 对136例断指再植术患者的护理进行回顾总结.结果 共再植136例185指,其中不完全离断144指,完全离断41指,离断时间20～600min,平均300min.按再植指计算,术后存活182指,存活率99.5%.结论 断指再植成功的关键取决于4个方面:高超的显微外科手术,耐心细致的心理护理,术后密切观察患指血运,以及指导患者正确的功能锻炼。

Nursing about 68 patients with vascular crisis when they have undergone the replantation of severed finger

随着显微外科技术的发展,指尖断指再植也突破了平面的限制获得了较高的成功率[1,2].但是术后由于解剖、伤情、血流和血液、精神环境等因素的影响所导致的血管危象,则严重影响着再植指的成活.2000年12月-2004年12月,我科对412例指尖断指再植发生血管危象的68例指,采用积极、主动的护理措施,密切观察,妥善处理,取得了满意效果,现报道如下。

Local analgesia and anti- vasospasm following replantation of severed fingers

目的 探讨断指再植术后局部镇痛、抗痉挛的临床应用.方法2003年4～12月收治断指再植病例22例26指,随机分为L、M组,L组为对照组:采用目前术后常规镇痛方法;M组为试验组:采用局部镇痛、抗痉挛治疗.结果两组病例再植术后疼痛VAS评分有显著差异,M组明显低于L组,M组14例17指均成活,术后无一例发生血管危象.L组8例9指成活8指,1指术后发生血管危象失败.结论再植术后局部镇痛、抗痉挛方法镇痛效果良好、应用安全,对血管痉挛、血管危象具有良好预防和治疗作用。