Reattachment Research Articles

Thoracic discectomy via trans-facet-joint approach

Objective To evaluate the clinical effect of thoracic discectomy via trans-facet-joint approach in the treatment of thoracic disc herniation.Methods Thirty-three cases were included in this group from October 1994 to August 2009.There were 27 males and 6 females.The age ranged from 18 to 72 years old,with an average of 41.8 years.The course of disease ranged from 12 days to 36 months and was lesser than one month in 13 cases.The weakness and numbness of lower limbs occurred after trauma in 9 cases.Fifteen cases were diagnosed as simple thoracic disc herniation.Six cases were associated with ossification of posterior longitudinal ligament and 12 cases were associated with ossification or hypertrophy of yellow ligament.A total of 45 discs were involved,including 32 in lower thoracic segments(71.11%),8 in upper thoracic segments(17.78%)and 5 in middle thoracic segments(11.11%).All the herniated discs and the ossified OPLL were excised via the trans-facet-joint approach.For the cases with ossification or hypertrophy of yellow ligament,the laminectomy and replantation were performed.The screw-rod system was used on both sides in 14 cases,on one side in 19 cases.Results Follow-up was acquired in 27 patients,ranged from 12 to 63 months(mean,37 months).According to Epstein and Schwall grade,there were excellent in 15 cases,good in 10 cases,improved in 2 cases and poor in 2 cases.The excellent and good rate was 86.21% and total effective rate was 93.10%.Postoperative complications occurred in 3 cases,including exacerbation of preexisting deficits in 2 cases and implant failure in 1 case.The former 2 cases were treated with methylprednisolone,dehydrant,neural nutrition and hyperbaric oxygen.One patient had recovered to preoperative level,the other had not recovered to the preoperative level.The implant was removed 18 months after operation for the implant failure.The post-operative CT or MRI showed that all the replanted lamina obtained fusion,and the canal decompression was complete.Conclusion Thoracic discectomy via trans-facet-joint approach can improve the clinical result obviously. Key words: Thoracic vertebrae; Spinal stenosis; Intervertebral disk displacement; Diskectomy

The clinical features and replantation strategies of Crushed amputations at the distal fingers in children

Objective To investigate the clinical features of crushed amputations at the distal fingers in children, summarize strategies for handling the vessels in replantation and assess its clinical outcomes. Methods From January 2005 to August 2009, 38 severed fingers in 28 patients of 11 months to 11.5 years old were replanted. The vessels were anastomosed under 12X to 15X magnification based on the vascular characteristics according to Ishikawa's classification. Results Tirty-five out of the 38 replanted fingers survived, while only 3 necrosed. The survival rate was 92.1%. Postoperative follow-up ranged from 3 months to 3 years. Satisfactory results in terms of the contours of finger nail and pulp, and finger length were achieved in all the survived cases except for mild lateral deviation deformity in three cases due to the crushing injury of epiphysis in zone Ⅳ. According to the functional evaluation criteria formulated by Chinese Hand Surgery Society, results were excellent in 18 cases, good in 14 cases, and poor in 3 cases. The overall excellent-good rate was 91.4%. Conclusion Blunt injury is the common cause of distal finger amputation in children, mostly manifested as crushed amputations. Satisfactory results can be obtained provided that the surgeon is familiar with the vascular anatomy of the distal finger, and that meticulous debridement and precise vascular anastomosis are done. Therefore, the crushed amputations at the distal fingers in children are also the candidates for replantation and should be replanted aggressively. Key words: Microsurgery; Replantation; Child

Three-dimensional numerical simulation of stably stratified flows over a two-dimensional hill: effect of stratification on the non-periodic separation and reattachment of the flow

Stably stratified flows over a two-dimensional hill are investigated in a channel of finite depth using a three-dimensional direct numerical simulation (DNS). The present study follows on to our previous two-dimensional DNS studies of stably stratified flows over a hill in a channel of finite depth and provides a more realistic simulation of atmospheric flows than our previous studies. A hill with a constant cross-section in the spanwise (y) direction is placed in a 3-D computational domain. As in the previous 2-D simulations, to avoid the effect of the ground boundary layer that develops upstream of the hill, no-slip conditions are imposed only on the hill surface and the surface downstream of the hill; slip conditions are imposed on the surface upstream of the hill. The simulated 3-D flows are discussed by comparing them to the simulated 2-D flows with a focus on the effect of the stable stratification on the non-periodic separation and reattachment of the flow behind the hill. In neutral (K = 0, where K is a non-dimensional stability parameter) and weakly stable (K = 0.8) conditions, 3-D flows over a hill differ clearly from 2-D flows over a hill mainly because of the three-dimensionality of the flow, that is the development of a spanwise flow component in the 3-D flows. In highly stable conditions (K = 1, 1.3), long-wavelength lee waves develop downstream of the hill in both 2-D and 3-D flows, and the behaviors of the 2-D and 3-D flows are similar in the vicinity of the hill. In other words, the spanwise component of the 3-D flows is strongly suppressed in highly stable conditions, and the flow in the vicinity of the hill becomes approximately two-dimensional in the x and z directions.

A preliminary study on the classification of mutilated injuries of the radial side of the hand

Objective To investigate the classification of mutilated injuries of the radial side of the hand and the clinical outcomes of primary repair. Method A retrospective study of 129 cases of mutilated injuries of the radial side of the hand was carried out. The injuries were divided into five types. In type Ⅰ the mutilated injury only involved the thumb (54 cases). In type Ⅱ the mutilated thumb was accompanied by skin defect of the first web space (33 cases). In type Ⅲ both the thumb and index finger were mutilated along with skin defect of the first web space ( 10 cases). Type Ⅳ involved mutilated injuries of the thumb, index finger and long finger,and skin defect of the first web space (29 cases). In Type Ⅴ the mutilated injuries involved the thumb, index finger, long finger and the radial side of the palm, along with skin defect of the first web space (3 cases).According to the different injury types, various reconstruction strategies were used including toe-to-thumb transfer or heterotopic replantation of the remaining finger for thumb reconstruction, anterolateral thigh flap, dorsalis pedis flap or lateral arm flap for resurfacing of the radial side of the hand. Results Out of the total 129 cases, the transferred flaps and toes or heterotopically replanted fingers in 128 cases survived. The overall survival rate was 99.2%. The patients were follow-up for 1 to 4 years. According to the provisional functional assessment criteria for upper limb issued by the Hand Surgery Society of Chinese Medical Association, the functional recovery was rated as excellent in 46 cases, good in 61 cases, acceptable in 19 cases, and poor in 3 cases. The overall excellent and good rate was 82.9%. Conclusion Classification of mutilated injuries of the radial side of the hand is useful for the selection of proper operative procedures. The clinical outcome is satisfactory after functional reconstruction with primary repair. Key words: Hand; Wounds and injuries; Reconstructive surgical procedures; Typing

Qualitative research on patients' experiences undergoing digit replantation

Objective To explore patients'experiences undergoing digit replantation. Methods Data were collected through deep interviews with 9 patients undergoing digit replantation and analyzed by phenomenological hermeneutic method. Results Patients' experiences undergoing digit replantation fell into four themes: ( 1 ) self -concept changes; (2) social adaptability changes; (3) emotional changess; (4) future life concerns. Conclusions Medical staff should pay more attention to patients' experiences and timely adjust the psychological status of patients, in order to the success of replantation and functional rehabilitation. Key words: Qualitative research; Digit replantation; Patients'experience

Damage control of severe limb(finger) with multiple injuries

Objective To explore the strategy of damage control in clinic treatment of severe limb (finger) with multiple injuries.Methods Severe multiple injuries patients with ISS evaluation more than 16 points were chosen for this study.Simple replatations of severed limb(finger) were perfored in 40 patients while their multiple injuries were actively treated.Results Among the 40 cases, all cases survived.1-3 years follow-up showed that the results were excellet in 8, good in 21, middle in 7, and poor in 4, with an excellent or good rate of 72.5 percent.Conclusion Multiple specialties cooperation, early treatment of multiple injuries and experienced microsurgery operation are the keys to improve success rate of replantation of severed limb(linger) with multiple injuries. Key words: Severed limb(finger) replantation; Multiple injuries; Microsurgery; Damage control orthopetics

Influence factor of the prognosis of traumatic subretinal hemorrhage after vitreo-retinal surgery

Objective To evaluate the influence factor of the prognosis of traumatic subretinal hemorrhage after vitreo-retinal surgery. Methods The clinical data of 50 patients with traumatic subretinal hemorrhage who had undergone vitreo-retinal surgery were retrospectively analyzed. All patients had ocular traurnatie history and subretinal hemorrhage diagnosed by fundus and B-scan examination; the preoperative visual acuity was less than 0. 1. According to different conditions, the traumatic eyes were treated with vitreo-retinal surgery, combined with lensectomy, retinotomy or silicone oil tamponade, respectively. The period of follow-up after surgery was 2-53 months, and the average period was 7.27 months. The corrected visual acuity and retinal reattachment at the last follow-up were observed. The visual acuity ≥0. 1 was the standard of good prognosis; retina[ reattachment was observed by indirect ophthalmoscope and color fundus photography. The prognostic factors mainly included type of injury, open or closed injury, the disease course, preoperative visual acuity, retinal detachment, hemorrhagic choroidal detachment, vitreous hemorrhage, the sites of submacular hemorrhage, methods of surgery. The relationships between those prognostic factors and visual acuity outcome or retinal reattachment were analyzed by χ2 test and logistic regression analysis. Results About 46.0% patients had good prognosis of the visualacuity. In the eyes with preoperative visual acuity of no light perception to hand moving and finger counting to 0. 1, the rate of good visual aeuitywas 34. 2% and 83.3%, respectively; the difference between the two groups was significant(χ2=8. 860, P = 0.003). In the eyes with or without preoperative retinal detachment, the rate of good visual acuity was 37.5% and 80. 0%, respectively; the difference between the two groups was significant (χ2=4. 232,P=0. 040). In the eyes with subretinal hemorrhage involving the macular fovea or not, the rate of good visual acuity was 34.4% and 66.7%, respectively; the difference between the two groups wassignificant (χ2 =4. 836,P=0. 028). All the other prognostic factors had no obvious effect on the retinal reattachment after the surgery. Conclusion Preoperative visual acuity, retinal detachment and submacular retinal hemorrhage were the important influence factors associated with prognostic visual acuity of eyes with traumatic subretinal hemorrhage after vitreo-retinal surgery. Key words: Eye Injuries/therapy; Vitrectomy; Prognosis

Female duplication of kidney ureter and bladder:9 cases report

Objective To report the experiences on the diagnosis and treatment of duplication of kidney ureter and bladder. Methods Nine cases of duplication of kidney ureter and bladder from 1996 to 2008 were reviewed.Six cases of duplicated kidney ureter occurred in the left side and 2 cases in the right side,1 case bilateral kidney ureteral duplication.Of 8 cases with unilateral duplicated,duplicated bladders were incompleteness.And the patient with bilateral duplicated,whose duplicated bladder was completeness,was diagnosed with duplication of urethra,uterine,bilateral ovary and oviduet tubes,and also suffered from duplicated uterine prolapse Ⅱ,vaginal anterior wall bulging and duplicated vesicocele.There were two cases whose duplicated kidney losed function because of severe hydronephrosis,and 7 cases existed kidney secretion function. Excision of duplicated kidney ureter and bladder were performed on 2 cases with non-functional duplicated kidney.6 cases had undergone duplicated bladder excision and duplicated ureteral bladder replantation.The special case had undergone duplicated urinary bladder urethra uterine and bilateral annexes excision,and duplicated ureteral bladder replantation. Results The operation was successful in all paients without leakage and ureter stump syndrome.Three months after operation,ureter bladder imaging showed no ureteral reflux in 7 cases of ureteral bladder replantation.IVU were reviewed 12 months after operation:2 cases undergoing duplicated kidney excision showed that the function of residual kidney were normal,7 cases of replantation that the shape and function of sick side kidney and duplicated kidney were good. The patient who suffered from duplicated uterine simultaneously got pregnancy 1.5 years after operation. Conclsions Image examinations may help to diagnose the duplication of kidney ureter and bladder. The main treatment is surgery. Understanding the function of duplicated kidney and the shape of kidney ureter and bladder should be considered before operation. The goal of surgery should be relieving pain,protecting the function of duplicated kidney and minimizing the risk of infection. Key words: Female; Urogenital abnormalities; Ureterovesical reimplantation

Replantation of degloved fingertips

Objective To investigate the surgical indications and techniques of fingertip replantation in degloving injuries.Methods From 2005 to 2009,21 finger tips with degloving injury in 14 cases were mplanted.Reperfusion of the replants was achieved by digital artery anastomosis in all 21 fingers.Venous drainage was handled by anastomosis of finger pulp vein in 7 fingers,vein-to-dlgital artery anastomosis in 2fingers,and wound drainage with a rubber drain and saline irrigation without vein anastomose in 12 fingers.Results Twenty fingers survived while one finger necrosed.The survival rote was 95.2%.Nine cases with 15fingers were follow-up for 4 months to 2 years.The appearance of the replanted fingers,especially the finger nail,was satisfactory.Range of motion of the distal interphalangeal joints was normal.2-point discrimination averaged 4 mm.Conclusion Replantation of degloved fingertips leads to good functional recovery.Replantation should be attempted whenever there is anastomoseabled artery,regardless of the vein conditions. Key words: Finger injuries; Microsurgery; Replantation; Degloving injuries

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

Knowledge of 1st-4th-Grade Teachers from Municipal Public Schools of the City of Manaus/AM about Tooth Avulsion

Objective: To evaluate the knowledge of 1st-4th grade teachers form municipal public schools of the city of Manaus/AM about tooth avulsion. Method: Three hundred and eleven professionals from all regions of the city of Manaus/AM were interviewed using a standardized form containing closed, open and multiple-choice questions about tooth avulsion, tooth replantation and the procedures necessary to improve the prognosis in cases of avulsed teeth. After the interview, a folder containing information about the correct urgency procedures to be adopted in case of tooth avulsion was handed to the participants, in an attempt to make elementary public school teachers capable of spreading this knowledge. Results: 57.1% of the teachers had only high school education and 49.8% had 1 to 5 years of professional experience. From the teachers that attended first-aid training (29.9%), only 12.9% had previous information on dentoalveolar trauma. 66.9% could not distinguish primary from permanent teeth, and 61.7% would only give a towel for the student to bite in case of dental trauma, not dispensing the necessary attention to the avulsed tooth. Only 5.5% would replant the avulsed tooth at the site of the accident. Most teachers (55.9%) responded that immediate dental care is necessary, 51.1% considered the dentist as the most qualified professional for these cases, and 58.8% would choose tap water as the ideal storage medium for the avulsed tooth. Conclusion: The interviewed teachers did not have adequate knowledge of the urgency procedures to be adopted in case of tooth avulsion, demonstrating the need of incorporating this subject to the curriculum of these professionals and performing health educational campaigns to improve the frequency and prognosis of replanted teeth.

Nursing of replantation of amputated finger patients accepting brachial plexus block analgesia and patient-controlled sedation

Objective To probe into nursing management methods of replantation of amputated finger patients accepting brachial plexus block analgesia and patient-controlled sedation (PCS) after operation.Methods 48 patients of replantation of amputated fingers accept continuous brachial plexus block analgesia and PCS after operation,Analgesia was 0.2% ropivaeaine,sedation was 0.05% midazolam or compositive liquid mixed 0.05% midazolam and 0.0005% fentanyl,the visual analogue scale (VAS),sedation scores and the changes of vital signs and side effocts after operation were recorded before the operation and at time intervals of 6,12,24,48,72 hours after the operation.Results The visual analogue scale(VAS)in the post-operation was obviously lower than the pre-operation,the Ramsay scores of PCS were higher than the pro-operation.There was no inadequate or excessive sedation.No influence was seen on respiration,circulation system and no other side effects happened.Conclusions Brachial plexus block analgesia and patient-controlled sedation (PCS) can offer a good Analgesia and sedation effect for patients of amputated fingers replantation,in period of analgesia and sedation,we should strengthen nursing and monitoring of vital signs to avoid accident. Key words: Analgesia; Patient-conlrolled sedation; Replantation of amputated finger; Nursing

Post-operation nursing of replantation of amputated finger soaked in fluid

Objective To approach the postoperative care method of replantation of amputated finger soaked in fluid.Methods Observation and care of patients' condition were applied to the 25 cases of totally 41 replantation of amputated fingers soaked in fluid from may 2005 to may 2008 after operation.Results Achievement ration was 90% in 25 cases of 41 replantation of amputated fingers.Conclusions Close observation and proper nursing intervention on the operative fingers are the important guarantee to the replantation of amputated fingers. Key words: Fluid; Amputated finger; Nursingord; Nursing

Cause analysis and management of vascular crisis in digital replantation

Objective To propose prevention and management of vascular crisis according to cause analysis, and improve the survival rate of digital replantation. Methods The vascular crisis of 132 digits of 98 cases were observed during intraoperative. The replantation was performed under different time and different conditions. The causes of vascular crisis, and propose effective prevention and management of vascular crisis were restrospective analysis. Results From March 2006 to June 2007, 35 amputated digits occurred vascular crisis during intraoperative, 19 amputated digits occurred during postoperative. After using warm physiological saline and injecting the papaverine partly, we proceed operations research with regard to the non-catabatic amputated digits. As result 58 digits survived, the achievement ratio was 89.2%. From July 2007 to March 2009, 10 amputated digits occurred vascular crisis during intraoperative,5 amputated digits occurred during postoperative. After non-surgical treatment, we performed operations research regard to the non-catabatic amputated digits. After blood supply recover, we imbed PCA pump into flex tendinous sheath to avoid the occurrence of vascular crisis postoperative. As result 66 digits survived, the achievement ratio was 98.5%. postoperative 9 cases out of fullow-up, 89 cases follow up ranged from 6 to 8 months. Recovery of the hand function was good. Conclusion Good and adequate anesthetic and an appropriate ambient temperature during operation are important factors to prevent occurrence of vascular crisis in digital replantation. Paying enough attention to these factors can effectively improve the survival rate of replantatian. Key words: Digital replantation; Vascular crisis; Microsurgery

Clinical characteristics and therapeutic effect of retinal detachment in aphakic and pseudophakic eyes in 805 patients

Objective To observe the clinical characteristics and therapeutic effect of aphakic retinal detachment (ARD) eyes and pseudophakic retinal detachment (PPRD) eyes.Methods The clinical data of 805 patients,including 321 ARD and 484 PPRD eyes were retrospectively analyzed.The patients'visiual acuity,refraction,intraocular pressure were examined,and the patients also underwent slit-lamp microscopy and direct and (or) indirect ophthalmoscopy.The preoperative best-corrected visual acuity (BCVA) was between light perception (LP) and 0.6.Mainly according to the PVR grade and retinal holes position to take the scleral buckling or vitrectomy combined with scleral buckling.The 805 eyes were divided into 1995-1999 group (243 eyes) and 2000-2007 group (562 eyes) according to operative time.The follow-up ranged from 3 to 25 months,with an average of 12.3 months.The success standard of surgery was set as anatomic retinal reattachment and the last follow-up time was considered as the judgment time.The surgical complications were recorded at each follow-up time points.The composition of PPRD,the visual acuity,ocular lesions,surgical methods and results before operation and visual acuity after operation in two groups were analyzed and compared by Mantel-Haenszel chi-square test.Results The average interval from lens extraction to RD occurrence was 15.4 months in PPRD eyes and 39.1 months in ARD eyes.The final total anatomic success rate was 95.9%,and was 93.5% in the scleral buckle eyes and 97.2% in vitrectomy eyes.The BCVA was better than 0.3 after operation only in 11.9% of the 805 patiens,and the visual acuity increased more than 2 lines in 67.3%.Compared with the ARD eyes,early onset,high proportion of total posterior vitreous detachment,severe PVR,wide RD range,low detection rate of retinal hole and low antomic success rate were found in PPRD eyes.Compared with the 1995-1999 group,the proportion of vitreous surgery,anatomic success rate and better visual acuity were found in 2000-2007 group.Conclusions The ocular lesions of ARD and PPRD is more complicated,the therapeutic effect are improving in recent years. Key words: Retinal detachment/etiology; Retinal detachment/diagnosis; Retinal detachment/surgery; Aphakia; Aphakia,postcataract; Phakic intraocular lenses

망막박리에서 일차수술로 유리체절제술과 실리콘 주입술에 대한 임상결과 분석

본 연구는 망막박리에서 실리콘 기름주입술에 대한 임상적 결과를 분석한 것이다. 1999년부터 2002년까지 유리체절제술과 실리콘기름 주입술를 받은 44명 환자의 45안을 연구하였다. 결과는 다음과 같다. 1. 유리체절제술 후 시력이 두 줄 이상 호전된 경우는 45안 중 24안(53%)이었으며, 45안 중 18안(40%)에서는 시력의 변화가 없었다. 2. 실리콘기름 주입술 후 16안(6.3%)에서 실리콘기름을 제거하였으며 그 중 1안에서 망막박리가 재발되어 실리콘기름 재주입술을 시행하여 망막재유착을 이루었다. 3. 재수술을 포함하여 해부학적인 재유착은 45안 중 44안(97%)에서 이루었다. 4. 실리콘기름주입 후 발생한 합병증은 백내장(16안), 녹내장(10안), 실리콘기름의 유화(5안), 각막병증(2안), 재발성 망막박리 (1안)이었다. 결론적으로 망막박리 환자에게 일차수술로 유리체 절제술 후 유리체 대용물로 실리콘 기름을 사용하는 것은 여러 합병증의 발생에도 불구하고 높은 해부학적 성공률과 시력 개선효과를 보여주었다. 【To evaluate clinical results of silicone oil injection for retinal detachment. The 45 eyes of 44 patients underwent vitrectomy and silicone oil injection from 1999 to 2002. 1.There were no history of previous retinal surgery and ocular trauma. In 24 of the 45 eyes(53%) visual acuity increased and stabilized in 18 of the 45 eyes(40%). 2. 1 of 16 eyes(6.3%) had recurred retinal detachment after silicone oil removal. 3. Final retinal reattachment was achieved in 44 eyes(97%). Postoperative complications were cataract(16 eyes), glaucoma(10 eyes), emulsification of silicone oil(5 eyes), keratopathy(2 eyes) and recurrent retinal detachment(1 eye). These results show that silicone oil injection for primary retinal detachment yields a high rate of anatomic success and the good visual outcome】

Ultrasound-guided brachial plexus catheterization finger replantation for postoperative analgesia

Objective To study the ultrasound-guided brachial plexus catheterization finger replantation in the guidance ofthe value of postoperative analgesia.Methods 80 cases of emergency means to be a line or two referring to digital replantation patients(male 58 cases,22 cases of women),aged 17～67-year-old,ASA I ～III-class,non-traumatic neck and brachial plexus injury,by means of postoperative analgesia were randomly divided into continuous brachial plexus block(PCBA group)and intravenous analgesia group(PCIA group).Visual analog scale(VAS)were patients of the 24 h and 48 h after the sedative and analgesic evahation of the extent of,and record the emergence of nausea,vomiting,complications such as phrenic nerve block several of the cases.Results All patients were able to comfortably accept the ultrasound-guided brachial plexus puncture process,the exact effect of intraoperative anesthesia.that of PCBA Group of ultrasound-guided brachial plexus puncture the smooth process,all successfully.PCBA group compared with the PCIA group,VAS score and sedation extent there was a significant difference(P<0.01),PCIA vasospasm group and incidence of nausea and vomiting was higher than PCBA Group.Conclusion Ultrasound-guided brachial plexus nerve catheterization with positioning accuracy,the success rate is high;and PCBA group replantation better means to improve the blood supply,improve the survival rate of replanted digits to avoid the added opioid-induced nausea,vomiting and other complications,increase patient comfort. Key words: Ultrasound-guided; Brachial plexus; Catheterization; Postopercotive analgesia

An analysis of practical time on bleed of finger in venous crisis after replantation

Objective To explore the practical time on bleed of finger in venous crisis after replantation.Methods A total of 40 fingers in 38 cases in which venous crisis occurred were cured by being bled from 2001～2005.The cases were divided into two groups by the time when venous crisis occurred which was regarded as a dominating factor.The fingers in which venous crisis occurred within 72 hours was named group A;yet those ones in which venous crisis occurred after 72 hours was named group B.Results There were 24 fingers in which venous crisis occurred within 72 hours,16 fingers after 72 hours.While there were 4 fingers alive and 20 fingers dead in group A;13 alive and 3 dead in group B.The living rate of group B was evidently higher than that of group A.Conclusion The later venous crisis occurrs,the higher the living rate of the fingers cured by being bled is.The method of bleed should be taken seriously for the fingers in which venous crisis occurred within 72 hours;while it should be taken actively for the fingers in which venous crisis occurred after 72 hours. Key words: Replantation of finger; Venous crisis; Bloodletting

The application of bioabsorbable Poly-DL-Lactic Acid (PDLLA) screws in digit replantation

Objective To evaluate the clinical results of using bioabsorbable PDLLA screws for bone fixation in digit replantation. Methods From October 2005 to October 2007, bioabsorbable PDLLA screw was used as an intramedullary pin to fix the fracture in 9 cases of digit replantation. The fingers were severed at the middle phalanx in 4 patients and at the proximal phalanx in 5 patients. Plaster was removed 3 to 4 weeks after the surgery and protected rehabilitation was initiated. Results All the replanted fingers survived. There was no fracture displacement or loosening of the screw. All fractures achieved bone healing at 6 to 8 weeks after the operation. The patients were followed up for 6 to 28 months, with an average of 12.6 months. No edema, exudation or infection of the wound was noted. Functional recovery of the replanted fingers was good. Conclusion Intramedullary fixation using bioabsorbable PDLLA screw is an effective method for fracture fixation in digit replantation. The technique allows early mobilization, which benefits the functional recovery of injured digits. Key words: Fingers; Replantation; Fracture fixation; internal; Bioabsorbable

Therapeutic effect of exposed wound care at different time point after finger replatation

Objective To explore the influence to nursing efficiency using exposed wound care ( EWC) at different time point after finger replantation. Methods 60S patients after finger replantation were recruited according to selection criteria and were randomly divided into 4 groups. 136 cases in group A were treated with EWC without gauze dressing cover 1 to 2 hours after operation. 183 cases in group B were treated with EWC 6 to 8 hours after operation. 159 cases group C were treated with EWC 12 to 24 hours after operation. 127 cases in group D were treated with gauze dresssing cover all the time until taking the stiches out ( 14 days). Blood circulation, wound infection, finger survival rate, medical costs were observed and compared among 4 groups. Results Compared with the other 3 groups, group B had better outcomes including blood circulation, wound infection, survival rate and medical costs of replanted finger. The EWC therapy could decrease expenditures of inpatient, length of stay, and incidence of complications. Conclusions The EWC therapy should be used 6 to 8 hours after operation when dressing oozing did not dry completely. That therapy can decrease the incidence of blood vessel crisis of replanted finger, reduce medical expenditures and improve survival rate of replanted finger. Key words: Exposed wound care; Finger replantation; Time point; Wound care