Release date: 2017-01-11 Some time ago, a case in the garden caused widespread discussion. It is reported that the case was a replantation of a limb in the 89 hospital of the Chinese People's Liberation Army, which lasted 17 hours, and all of the 6 segments and 9 segments were all alive. Broken limb (referring to) replantation surgery is not a myth Colleagues familiar with the development of trauma medicine may know that as early as 1963, China’s Academician Chen Zhongwei first reported the case of replantation of severed limbs, and in 1965, successfully replanted the severed fingers, and then the technique of replanting the limbs was widely recognized and Promote the application. With the introduction and improvement of microsurgical technology, the technical level of replantation of broken limbs in China is the world leader. As of 1984, according to statistics from Academician Chen Zhongwei, the total survival rate of replanted limbs in the country was 83.9%. In 1986, there were reports of replantation of 10 fingers and complete survival. The successful replantation of multiple segments of the fingers was reported in 1989. It can be seen that the surgery in the above example is not very surprising in the eyes of China's outstanding hand surgeons. Where does China's good technology come from? So why is China's broken limb (referred to) replanting technology so good? First of all, everyone will think of a large population base. Once the technique of replantation of broken fingers has been carried out, the technology has been studied from the top three to the village health center. As of 2003, more than 60,000 cases of replanted limbs were replanted nationwide, compared with only 2% of hospitals in the United States who are willing to replant their fingers, and each hospital has an average of more than 10 units per year. A lot of training has certainly improved the technical level of our country. On the other hand, the influence of the traditional culture of "body's body, the parents, the filial piety, and the filial piety." Compared with the restoration of function, some patients care more about the integrity of the shape. Our doctors also pursue "The beauty of surgery" relaxes the indications for replantation of the broken limbs. Preoperative assessment of limb replantation (referring to) replantation: Protecting patients' lives is a priority. In the case of other damages, first solve the life-threatening problem and then consider the replantation of the limbs to avoid interference. Because of the older age, heavier trauma and other reasons, patients with poor surgical tolerance, even if surgery, strengthen the monitoring to ensure safety. Isolation time of the limb. Fingers are more tolerant to ischemia, but the shorter the time to establish blood supply, the better the survival and functional recovery. Too long ischemic time can cause irreversible changes in the limbs, especially muscle tissue, and may even cause serious complications after replantation to restore blood supply. Judgment of the break. Sharp cut injury is a good condition for replantation, while the relative prognosis of avulsion injury and blast injury with severe soft tissue injury is not so good. Replantation of multiple fracture planes is more difficult to restore function than single plane disconnection. The disconnected part should also be considered. For example, the indication that the proximal segment is a relatively contraindication to replanting, so as to avoid the non-functional finger, but affects the grasping function. Assess the extent to which the feature is restored. Replantation survival does not mean success. If the postoperative recovery function is not good, the patient should fully understand the point before replanting and make decisions to avoid the pain caused by non-functional limbs. It’s not enough to have a beautiful surgery. As early as 2003, Professor Cheng Guoliang’s discussion on the replantation of broken limbs pointed out that the restoration of function after replanting in China is still unsatisfactory. Except for the replantation of the thumb and the distal segment of the finger, most of the finger replantation only restores the pinching function, and the function of the grip is not even difficult to pinch. Some deformities, some finger atrophy, and in the paper report on replantation of severed fingers, said the shape function is satisfactory. At the academic exchange meeting, the information with better shape function was reflected, but it was rare to see a piece of information with the function of making a fist. It is also proposed that the purpose of replantation of the broken limb is to restore a complete and functional hand. The principle of selecting the indication for replantation of the broken limb should be: survival, shape, function, and the key is function. If the replanting survives in a poor shape, the non-functional fingers are not replanted successfully. In China, the re-planting of the limbs (referring to the limbs), postoperative complications such as long-term swelling of the body, local dysfunction, active extension and flexion dysfunction are still very common, fingertip collapse, finger sensation is not uncommon. The success of replantation of the severed finger is inseparable from the exquisite surgical technique, but it is also inseparable from the postoperative functional exercise. The first case of replantation of the broken limb mentioned above, although the operation was completed in 8 hours, it was used after the operation. Several months are the function of limb recovery. Replanted limbs should be removed if they are not functional, and patients who are replanted will often be reluctant to remove the prosthesis. Therefore, it is premature to say "in the annals" before the completion of the complete post-operative exercise and rehabilitation. 1 week after surgery, bedridden, raise the affected limb, strictly quit smoking and keep warm, closely observe the anti-inflammatory, anticoagulant, antispasmodic and analgesic treatment, timely treatment when vascular crisis occurs, and ensure survival in the early stage. 2 to 3 weeks after surgery, the joints can be passively moved to the functional position to avoid obvious pain. At this time, methods such as infrared irradiation and ultrashort wave electrotherapy can be appropriately intervened. At 4 to 8 weeks after surgery, the Kirschner wire of the fixed joint has been removed. On the basis of passive activity, the patient can be instructed to take active exercises such as flexion and extension, fist clenching, etc. When the activity reaches the maximum amplitude, continue to exert appropriate force to prevent the occurrence of tendon adhesion. The initial healing of the long-term fractures after surgery can increase the passive activity and resistance exercise, and promote the recovery of muscle strength through the gradually increasing resistance training, and improve the active activity of the joints. In short, replantation of severed limbs should be aimed at functional replantation with maximum recovery. When medical staff realize the importance of each link, it is the ideal treatment to truly solve the pain for patients and bring benefits to society. Finally, the gingxiangwang (dingxiangwang) questioned the follow-up of the 89 hospitals of the Chinese People's Liberation Army. According to the relevant doctors' reply: At present, the finger-to-finger survival, follow-up rehabilitation and functional exercise are underway, because of controversy, temporary function recovery results. Source: Lilac Garden (micro signal dingxiangwang) High Speed Centrifuge,Clinical Centrifuge,Laboratory Centrifuge,Lab Centrifuge Guangdong Widinlsa International Co.Ltd , https://www.gdwidinlsa.com
Chinese doctors create world-leading replantation techniques for limb replantation