People who cannot handle hand surgery and microsurgery find finger replantation to be a miraculous thing. I wonder from which perspective this matter should be viewed. From the perspective of medical technology itself, any doctor who has received formal training in hand surgery and microsurgery, and whose conditions for finger amputation are not very poor, can achieve the goal of finger amputation. From this perspective, it is not difficult. However, the most critical step in finger replantation is vascular anastomosis. As long as this step is successful, it greatly ensures the success rate of finger replantation surgery. So, what is vascular anastomosis and how should it be performed for finger replantation?
1、 What is vascular anastomosis? Vascular anastomosis is a type of vascular surgery that mainly involves performing anastomosis surgery on the severed ends of blood vessels. When a patient's blood vessels are cut by sharp objects or cause arteriovenous defects after debridement, anastomosis surgery can be performed on the severed end. Due to the difficulty of this surgical operation, the technical level of the doctor is relatively high. Generally, when performing finger replantation, the main focus is on anastomosing the arteries and veins. This is the fundamental condition for ensuring the survival of finger replantation, and it is also the most technically demanding part of finger replantation surgery. For this type of anastomosis method, it is generally necessary to first identify the arteries, then repair the intima and adventitia under a microscope, and then perform eight to ten zero lines under the microscope to anastomose the blood vessels.
2、 The vascular anastomosis method for finger replantation can be divided into two categories: suture method and non suture method.
1. Sewing methods are divided into three types: continuous through stitching, intermittent through stitching, and overlay stitching. ① Continuous penetration suture method: There are two or three fixed point suture methods, which are relatively fast but not very accurate in alignment, and can cause stenosis. They are suitable for blood vessels with a diameter greater than 4mm. ② Intermittent through suture method: the most commonly used and effective method, suitable for small blood vessels of different diameters and properties. It can achieve accurate alignment during suturing, avoid stenosis, but has many knots, takes a long time, and requires high operational requirements. ③ Overlapping suture method: Generally, only three stitches are needed to complete a blood vessel anastomosis, which takes about 10 minutes. The operation is relatively convenient, and there is no suture exposed on the inner surface of the blood vessel. However, the blood vessel must have sufficient length, and the caliber size of the two must be roughly equal.
2. Non suture methods can be divided into sleeve method, stapler method, and adhesive method. Non suture methods require special equipment, have limited clinical applications, and cannot be used for small caliber blood vessels, delicate pediatric blood vessels, or hardened blood vessels in the elderly. Therefore, suture methods are generally used.
In clinical practice, vascular staplers are also used as a method of vascular anastomosis, but. I think about the condition of arteries. It is generally recommended to use suturing method, which is more reliable. In addition, for this situation after surgery, there is already damage to the blood vessels, which can easily cause thrombosis, so subsequent anticoagulation is still crucial. In addition, it is important to keep warm as catching a cold can also cause vasospasm. Additionally, smoking should be avoided as smoke has a constricting effect on blood vessels and can also lead to the failure of finger replantation surgery.