ObjectiveTo introduce a new medical heat preservation device, and to explore the application value and effectiveness in replantation of severed fingers. MethodsThe medical heat preservation device was design, water was used as the heating medium, and temperature was set and controlled by microcomputer. Between November 2010 and January 2014, 421 cases undergoing replantation of severed fingers were divided into 2 groups. Within 9 days after operation, the medical heat preservation device was used in 210 cases (experimental group), and the conventional heat lamp was used in 211 cases (control group). There was no significant difference in gender, age, injury cause, the interval between injury and admission, injury finger side, and operation time between 2 groups (P>0.05). The vascular crisis rate, success rate of replantation of severed fingers, comfort, sleep quality, and the influence on roommates were compared. ResultsThe comfort and the influence on roommates were good in 188 cases (89.52%) and 201 cases (95.71%) in the experimental group, which were significantly higher than those in the control group (25/211, 11.85%; 145/211, 68.72%). According to Pittsburgh sleep quality index (PSQI) for sleep quality, the results were good in 105 cases, fair in 85 cases, and poor in 20 cases in the experimental group; the results were good in 45 cases, fair in 95 cases, and poor in 71 cases in the control group. Blood vessel crisis occurred in 35 cases (16.67%) of the experimental group, which was significantly lower than that in the control group (76/211, 36.02%) (P<0.05). The survival rate of replantation in the experimental group (196/210, 93.3%) was significantly higher than that in the control group (181/211, 85.78%) (P<0.05). Significant differences were found between 2 groups (P<0.05) in above indexs. ConclusionMedical heat preservation device for replantation of severed fingers can improve the comfortable degree of patients and the quality of sleep, increase the survival rate of finger replantation, and reduce the occurrence of vascular crisis after operation.
Objective To study the effect of internal fixation with absorbable intramedullary nail on the treatment of phalange fractures in replantation of severed finger. Methods From September 2001 to October 2003, 28 cases with industrial severed finger (21 males and 7 females, with the age of 18-35 years) were replanted within 1-6 hours. The severed locations were index fingers in 11 cases, middle fingers in 8 cases, ring fingers in 6 cases, little fingers in 3 cases. All cases of phalange fractures were fixed by absorbable intramedullary nails of poly-DL-lactic acid(PDLLA) that combined with chitosan. Out of the 28 cases, 15 cases were with proximal phalange, 11 cases were with middle phalange, 2 cases were with distal phalange. The bone marrow cavity of the phalanges were dilated, then the intramedullary nail was inserted with suitable diameter and length to fix the fracture. Postoperatively resin bandage was applied for 3-4 weeks.Results All the 28 patients survived the performance and postoperative follow-up ranged from 3 to 10 months(4 months in average). Rejection was observed in one case 3 weeks after operation, bone unions were obtained in other cases. According to the Chinese Medical Association’s evaluation standard for replantation of amputated finger, 18 fingers resulted in excellence, 9 fingers in good function and 1 with unsatisfactory function. The excellent and good rate was 96.4%. Conclusion Internal fixation with absorbable intramedullary nail of PDLLA combined with chitosan proves to be effective in the replantation of severed finger.
To investigate the significance of activated platelet levels before and after surgical operation in patients with severed finger by severe injury, the P-selectin (CD62p) positive platelet percent in peripheral blood was studied in 32 patients before and after operation by flow cytometric immunology. At the second and third day after operation, seventeen patients, which in a high positive platelet percent, were measured again after anticoagulation treatment with a large dose of urokinase etc. The results were that the levels of CD62p positive platelet in peripheral blood before and after operation were significantly higher than that of the normal group (P lt; 0.01). The CD62p positive platelet percent was increased not much more in the anti-coagulation patients than in the normal ones (P gt; 0.05). There were a few vascular crisis observed. This study suggested that severed fingers by a crushing or wringing injury enhance the platelet activity and resulted in hypercoagulation, thus anti-coagulation measures should be taken to avoid possible thrombosis and improve the survival rate of replantation. CD62p was one of the sensitive indices of activated platelet, which could be used in calculating hypercoagulation accurately.
In search of a new method for treating venous crisis after replantation of the finger, the effect of instantaneous, quick and forceful squeezing on the belly of replanted finger (the so-called SQUEEZINGG TECHNIQUE) was studied. In the animal experiment, 20 SD rats were used. The femoral veins and arteries were separated in order to measure the venous pressure. The result showed that the venous pressure was (8.33 +/- 1.29) x 10(-2) kPa in normal condition, (20.61 +/- 2.34) x 10(-2) kPa in the condition simulating venous crisis and (73.9 +/- 5.74) x 10(-2) kPa on carrying out the squeezing technique. The second part of the experiment was performed on ten human fingers which were amputated because of trauma or other diseases. One of the arteriae digitales palmares propriae and two of its accompanied veins were disected, and all other blood vessels were ligated. The artery was irrigated with normal saline at a pressure of 12 kPa. When both veins were left open, the venous pressure was (1.32 +/- 0.17) kPa; (4.29 +/- 0.49) kPa, when both were ligated; and (16.88 +/- 5.25) kPa when the squeezing technique was applied at the time venous crisis developed. From May 1991 to May 1996, this method was used for 43 times in 25 cases (35 fingers) with venous crisis after replantation. It was successful for 39 times in 21 cases (30 fingers). It was very important that the performer should use the thumb and the index finger to squeeze just the belly of the involved finger, and that every squeeze should be forceful, quick and instantaneous. It was suggested that if this method was properly performed it could improve the survival rate of replanted fingers. The mechanism of squeezing technique in the treatment of venous crisis following replantation of finger was proposed.
The method of diversion of the arteryvein flow was used for vascular anastomosis in 12 cases undergoing replantation of the severed limbs(fingers)and free tissue transplantations. The results from this method were successful. The efficacy of this method of re-establishment of the blood circulation broadened the indications for replantation and also provided a method of choice in cases when there was impediment of the venous return during tissue transplantation.
The comprehensive rehabilitative treatment was used in 58 cases(194 finger)for functional impairment after eplantation. After the treatment the overall increase of flexion-extension range of motion was 30 to 130 degrees respectively. From the assessment of 10 items of daily activities, the patients could accomplish three-fourth of them. the average time taken for the treatment was 3 months with an excellent-good rate about 87.4%. Through the early comprehensive rehabilititive treatment patients could achieve better results.