When the holiday comes, the hand injuries of children begin to increase gradually, and we must pay attention to protection. But accidents are always inevitable, and here I would like to say that the broken fingers of children are replanted.
Image from Qiantu Network
First, the success rate of replanting of children's broken fingers is high and difficult, and there are precedents in 1-year-old children
Figure 1: From July 2014 to August 2015, the First Affiliated Hospital of Sun Yat-sen University performed a total of 8 children (2-18 years old) with broken finger reimplantation, all of whom had fingertip injuries. The mean duration of postoperative follow-up was 9.3 ± 3.5 months (range, 6 to 15 months).
Finally, based on a monofilament examination (a nylon filament is used to check the sense of finger touch, temperature, solidity, pain, etc.), the sensory recovery of all patients is satisfactory. According to the s2PD test (Figure 2, testing the difference between the fingers with a disc), patients 2 and 5 achieved excellent results, and the rest of the patients did not perform this test because they were too small.
Younger children have less obstructed venous return after reimplantation and are of shorter duration than older children; therefore, the success rate of fingertip reimplantation is higher in younger children than in older children. Unlike adults, children have great adaptive potential, so re-internalization is usually close to normal, especially in younger children.
Children have a higher success rate of broken finger reimplantation due to faster soft tissue healing, less scarring, better nerve regeneration, enhanced tendon slippage, and easier joint movement. A 97% success rate has been reported for finger reimplantation in children (Figure 3).
However, as the news said, the caliber of the child's severed finger replantation blood vessel is too small, the technical difficulty is large, for the operation of the fingertip, the recovery of vascular function is more critical, there is less literature about children aged 1 and under, and the operation is not too much.
However, there is no precedent in China, and between August 1990 and March 2006, Xijing Hospital underwent the replanting of a 1-year-old child's finger. (Figure 4) And the small diameter of the vessels did not become the limiting factor for completing a high-quality anastomosis.
The study at Saigyo Hospital also found that the preservation method of the amputated part is an independent prognostic factor for survival, so post-injury preservation is very critical.
Second, it should be preserved in this way after a broken finger injury
(1) The broken finger should be wrapped with sterile gauze or relatively clean cloth to avoid direct exposure to the air;
(2) Put the wrapped broken finger into a plastic bag, tie the mouth of the bag tightly, and then put it into a container containing the ice water mixture, keep it relatively low, and send it to the hospital with the patient.
(3) Unless it is particularly dirty, it is generally not necessary to rinse.
(4) The broken finger cannot be directly soaked (including alcohol, water, disinfectant, etc.), and the broken finger cannot be directly contacted with ice water.
(5) If you can quickly seek medical treatment, and you really can't find something with a relatively low temperature, room temperature is also OK (note that this is a last resort, the study of Xijing University shows that there is no statistical difference between room temperature preservation and low temperature preservation (2 ° C ~ 6 ° C), indicating that the broken finger can withstand a long period of heat ischemia due to its small size)