Special Type of Finger Replantation Techniques and Cases Jian Lin He-Ping Zheng Yong-Qing Xu Tian-Hao Zhang 123 Special Type of Finger Replantation Jian Lin • He-Ping Zheng Yong-Qing Xu • Tian-Hao Zhang Special Type of Finger Replantation Techniques and Cases Jian Lin He-Ping Zheng Department of Orthopaedic Surgery Clinical Anatomic Center Xin-hua Hospital (ChongMing) Nanjing District General Hospital of PLA Shanghai, Shanghai Fuzhou, Fujian China China Yong-Qing Xu Tian-Hao Zhang Orthopaedic Department Department of Orthopaedic Surgery Kunming General Hospital of PLA Xin-hua Hospital (ChongMing) Kunming, Yunnan Shanghai, Shanghai China China ISBN 978-981-10-6228-5 ISBN 978-981-10-6229-2 (eBook) https://doi.org/10.1007/978-981-10-6229-2 Library of Congress Control Number: 2018931169 © Springer Nature Singapore Pte Ltd. 2018 This work is subject to copyright. All rights are reserved by the Publisher, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, reuse of illustrations, recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed. The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. The publisher, the authors and the editors are safe to assume that the advice and information in this book are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the editors give a warranty, express or implied, with respect to the material contained herein or for any errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Printed on acid-free paper This Springer imprint is published by Springer Nature The registered company is Springer Nature Singapore Pte Ltd. The registered company address is: 152 Beach Road, #21-01/04 Gateway East, Singapore 189721, Singapore Content Summary Special Types of Finger Replantation is a monograph of clinical cases and pictures. The authors have referred to the latest international literature, com- bined with their own valuable clinical experience and research results. The book consists of more than 200,000 words and includes more than 150 color pictures and drawings and over 500 photos of clinical surgery. The book is divided into two parts. One is the pandect part of finger replantation, mainly referring to the development of the history of replantation, hand anatomy, commonly used equipment and materials, frequently used medicines, preop- erative treatment, selection of anesthesia, regular replantation methods, post- operative treatment and management, and methods of functional recovery after finger replantation. The other part focuses on the concepts of 13 special types of finger replantation, case introductions, surgical key points and pre- cautions, etc., along with more than 60 representative cases including photos. Compared with similar books published all over the world, this book focuses more on the combination of systematic and thematic, basic theory and clini- cal practice, case photos and text description. This book is rich in illustrations, suitable for hand surgeons, foot surgeons, micro- and reconstructive surgeons, trauma surgeons, orthopedic surgeons, and plastic surgeons to read, follow, and carry out. We hope that this book promotes the technology of finger replantation. v Preface The human hands are the most valuable and a universal tool of labor. They are very easily damaged in everyday life, study, and work. The most serious dam- age to the hands is the severances. Without timely and effective treatment of replantation or reconstruction of the hand function, especially the special types of replantation, life-long harm to the patients may be caused. Thus, referring to the latest literature at home and abroad, combined with our own long years of clinical experience and research results, we have written this monograph, Special Types of Finger Replantation. We hope that this book plays a role in promoting this technology. Special Types of Finger Replantation consists of more than 200,000 words, more than 150 specimens, and over 500 photos of clinical surgery. The book is divided into two parts. The first part is general, introducing the history of the development of finger replantation; the anatomy of the hands; commonly used drugs, equipment, and materials; relevant matters of replantation before treatment; selection of anesthesia; routine replantation methods; treatment and management after replantation surgery; and postoperative functional rehabilitation methods and their significance. The second part focuses on the thirteen special types of replantation concepts, case introductions, and surgi- cal key points and precautions. We try do our best to achieve a systematic and thematic combination of basic theory and clinical practice as well as sample photos and text descriptions. The book is rich in content and illustrations; it is suitable for surgeons who specialize in hand surgery, microsurgery, trauma surgery, orthopedics, plastic surgery, etc. It is a valuable reference book for finger replantation and research. Because of our limited level of English, mistakes and errors in this book are inevitable. Please let us know of any such errors, so that they can be further corrected. As soon as the idea of a “special type” of replantation was put forward, it was supported and guided by Professor Hou Chunlin, who is the director of Chinese rehabilitation medicine and reconstructive surgery and director of the Chinese Medical Association. Famous clinical anatomist and Chinese academician, Professor Zhong Shizhen; the hand surgery expert vii viii Preface and academician at the Chinese Academy of Engineering, Professor Gu Yudong; and the chief editor of the Chinese Journal of Clinical Anatomy, Professor Xu Chuanda, carefully reviewed and revised the manuscript. Shanghai, China Jian Lin Fuzhou, China He-Ping Zheng Kunming, China Yong-Qing Xu Shanghai, China Tian-Hao Zhang Contents Part I Finger Replantation 1 The History of the Replantation of Amputated Fingers . . . . . . . 3 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 2 Applied Anatomy of the Hand . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 2.1 Holistic View . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 2.1.1 Hand Surface Landmarks . . . . . . . . . . . . . . . . . . . . . . . 5 2.1.2 Hand Posture . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 2.1.3 Body Surface Projection . . . . . . . . . . . . . . . . . . . . . . . 9 2.2 P alm . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 2.2.1 Superficial Layer Structure . . . . . . . . . . . . . . . . . . . . . 15 2.2.2 Middle Layer Structure . . . . . . . . . . . . . . . . . . . . . . . . 18 2.3 D orsum of the Hand . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 2.3.1 Superficial Layer Structure . . . . . . . . . . . . . . . . . . . . . 32 2.3.2 Deep Layer Structure . . . . . . . . . . . . . . . . . . . . . . . . . . 35 2.4 F ingers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 2.4.1 Superficial Layer Structure . . . . . . . . . . . . . . . . . . . . . 42 2.4.2 Deep Layer Structure . . . . . . . . . . . . . . . . . . . . . . . . . . 45 2.5 H and Bones and Joint . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 2.5.1 Hand Bones . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 2.5.2 Phalanges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 2.5.3 Hand Joints and Ligaments . . . . . . . . . . . . . . . . . . . . . 55 3 Replantation with Commonly Used Instruments, Equipment, and Materials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59 3.1 Microscope . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66 3.1.1 Micro-Instruments . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66 3.1.2 Micro-Tweezers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 3.1.3 Micro-Needle Holder . . . . . . . . . . . . . . . . . . . . . . . . . . 67 3.1.4 Micro-Scissors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 3.1.5 Hemostatic Clamp . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 3.1.6 External Diameter Measuring Ruler of the Blood Vessels . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 3.1.7 Micro-Irrigator . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 3.1.8 Notes on the Application of Microsurgical Instruments. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 3.1.9 Other Related Equipment . . . . . . . . . . . . . . . . . . . . . . . 68 ix x Contents 3.2 Commonly Used Materials . . . . . . . . . . . . . . . . . . . . . . . . . . . 68 3.2.1 Fracture Fixation Materials . . . . . . . . . . . . . . . . . . . . . 68 3.2.2 Nerve Repair Materials . . . . . . . . . . . . . . . . . . . . . . . . 68 3.2.3 Tendon Repair Materials . . . . . . . . . . . . . . . . . . . . . . . 68 3.2.4 Vascular Repair Materials . . . . . . . . . . . . . . . . . . . . . . 69 Bibliography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 4 C ommon Medicines Used after the Replantation of Amputated Fingers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71 4.1 D extran 40 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72 4.1.1 Adverse Reactions . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72 4.1.2 Precautions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72 4.2 Papaverine . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72 4.2.1 Adverse Reactions . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72 4.2.2 Precautions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73 4.3 Heparin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73 4.3.1 Adverse Reactions . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73 4.3.2 Precautions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73 4.4 Benzazoline . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73 4.5 Aspirin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74 4.5.1 Adverse Reactions . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74 4.5.2 Precautions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74 4.6 D ipyridamole . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75 4.6.1 Adverse Reactions . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75 4.6.2 Precautions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75 Bibliography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75 5 P reoperative Treatment for Replantation of Amputated Fingers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77 5.1 P reoperative Emergency Resuscitation . . . . . . . . . . . . . . . . . . 77 5.2 Assessment of General Conditions . . . . . . . . . . . . . . . . . . . . . 78 5.3 Evaluation of the Injury . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78 5.4 Preparation for Surgical Fields . . . . . . . . . . . . . . . . . . . . . . . . 79 5.5 Indications and Contraindications . . . . . . . . . . . . . . . . . . . . . . 80 5.6 S election of Anesthesia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80 6 S election of Anesthesia for Replantation of an Amputated Finger . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 6.1 N erve Block Anesthesia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 6.1.1 Brachial Plexus Block . . . . . . . . . . . . . . . . . . . . . . . . . 81 6.1.2 Other Nerve Block Anesthesia Methods . . . . . . . . . . . 86 6.2 General Anesthesia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87 Bibliography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88 7 Routine Surgical Procedures for the Replantation of Amputated Fingers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89 7.1 Effective Debridement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89 7.2 Reconstruction of Bony Framework . . . . . . . . . . . . . . . . . . . . 89 7.3 Tendon and Ligament Repair . . . . . . . . . . . . . . . . . . . . . . . . . . 91 7.4 Vascular Anastomosis Repair . . . . . . . . . . . . . . . . . . . . . . . . . 91 7.5 Nerve Repair . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92 7.6 Skin Suture, Wound Closure . . . . . . . . . . . . . . . . . . . . . . . . . . 92 Contents xi 8 Treatment and Management After the Replantation of Amputated Fingers . . . . . . . . . . . . . . . . . . . . 95 8.1 Conventional Treatment After Replantation of an Amputated Finger . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95 8.1.1 General Processing and Specialized Treatment . . . . . . 95 8.1.2 Drug Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96 8.1.3 Symptomatic Treatment . . . . . . . . . . . . . . . . . . . . . . . . 97 8.2 Postoperative Management of the Replantation of Amputated Fingers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97 8.2.1 Environmental Management . . . . . . . . . . . . . . . . . . . . 97 8.2.2 Management of Patient’s Body Position . . . . . . . . . . . 98 8.2.3 Drug Treatment Management . . . . . . . . . . . . . . . . . . . 98 8.2.4 Special Nocturnal Management . . . . . . . . . . . . . . . . . . 98 8.2.5 Patient’s Cognition and Emotional Management . . . . 98 8.2.6 Diagnosis and Processing of Vascular Crisis . . . . . . . . 99 Bibliography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102 9 Methods and Significance of Hand Rehabilitation for Finger Replantation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103 9.1 Replantation of Amputated Fingers, Functional Rehabilitation, Staged Treatment . . . . . . . . . . . . . . . . . . . . . . . 103 9.2 Common Finger Replantation Rehabilitation Therapy . . . . . . 104 9.2.1 Physiotherapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104 9.2.2 Exercise Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105 9.2.3 Occupational Therapy . . . . . . . . . . . . . . . . . . . . . . . . . 106 9.2.4 Application of a Brace . . . . . . . . . . . . . . . . . . . . . . . . . 107 9.2.5 Occupational Rehabilitation. . . . . . . . . . . . . . . . . . . . . 107 9.2.6 Traditional Rehabilitation Therapy . . . . . . . . . . . . . . . 107 9.2.7 Psychological Counseling . . . . . . . . . . . . . . . . . . . . . . 107 9.3 The Characteristics of Rehabilitation Treatment for Finger Replantation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107 9.4 The Meaning of Functional Rehabilitation . . . . . . . . . . . . . . . 108 Part II The Special Types of Finger Replantation 10 Replantation of Severed Fingers in Children . . . . . . . . . . . . . . . . 113 10.1 Overview of Replantation of Severed Fingers in Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113 10.2 Case Presentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113 10.3 Key Points of the Operation . . . . . . . . . . . . . . . . . . . . . . . . . . 122 10.4 Notes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123 References . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123 11 Transpositional Replantation of Severed Fingers . . . . . . . . . . . . 125 11.1 Summary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125 11.2 Case Presentation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125 11.3 Key Points . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136 11.4 N otes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137 Suggested Reading . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138