Shanghai Fourth Hospital successfully completed palm replantation surgery, Zhejiang workers had their palms severed by machines for hours | skin | machine
Recently, Zheng Jinlong, Li Jing, and others from the Department of Traumatology and Orthopedics, Shanghai Fourth People's Hospital Affiliated to Tongji University, worked tirelessly for four hours overnight to successfully perform replantation surgery on a severely injured patient from Wenling, Zhejiang who suffered from a severed palm due to a hinge fracture, and achieved successful blood supply reconstruction.
It is reported that on the evening of July 13th, Mr. Yang, a worker from Wenling City, Zhejiang Province, was accidentally hit by a machine while working in a factory, resulting in incomplete detachment of his left palm. Only the radial and ulnar edges of the tissue were connected, and the distal limbs were pale and bloodless. His skin sensation was lost, and he was urgently sent to the local hospital for emergency treatment. The local hospital diagnosed him with "left hand compression and detachment injury", which was complex. After simple bandaging, it was recommended to be immediately sent to a higher-level hospital, and the patient's family members were repeatedly informed that they must be transferred to a hospital with conditions for replantation surgery within 8 hours.
After 6 hours of rapid transportation, Mr. Yang arrived at the emergency department of Shanghai Fourth Hospital. The trauma orthopedic team led by Chen Aimin conducted a preliminary evaluation of the injury and found that Mr. Yang's left palm was mostly severed, with only the ulnar and radial edges of the tissue connected. A large area of skin peeling and damage was present on the dorsal side of his left palm, presenting as a dislodged injury appearance. Local skin and soft tissue defects were also present, with exposed tendons and bone matter. The peripheral blood supply of the left hand was poor, and sensory function was lost. The severed limb was still in good condition, with conditions for replantation. Under the guidance of Chen Aimin, the hand and foot microscopy team developed a detailed and feasible surgical plan. At the same time, the Shanghai Fourth Hospital Trauma Center immediately opened a green channel, and the anesthesia department operating room actively cooperated to prepare for surgery, buying time for limb replantation.
At 2am on July 14th, Mr. Yang was taken into the operating room. The hand and foot microsurgery team quickly completed debridement and appropriate expansion of the limbs, shortened the severed metacarpal bone in the left hand, reduced the fracture end, and fixed it with Kirschner wires. Under the microscope, four dorsal veins were anastomosed, and the dorsal branch of the radial artery was repaired to restore partial blood supply. Then, the superficial branch of the radial nerve and the dorsal branch of the ulnar nerve were repaired; Trim and anastomose the extensor tendon of the left dorsal finger, and design a local skin flap on the dorsal side to repair skin and soft tissue defects. Through debridement and exploration of the wound on the palmar side, it was found that both the superficial and deep palmar arches were ruptured, as well as the superficial branches of the ulnar nerve and the common palmar nerve of the fingers. The continuity of the deep and superficial flexor tendons of each finger was still acceptable. Under the microscope, the superficial branches of the ulnar nerve and the common palmar nerve of the fingers were repaired, and the superficial palmar arches were anastomosed at both ends to suture the wound.
After the surgery, Mr. Yang was transferred back to the orthopedic ward. After one week of observation, under the meticulous treatment and meticulous care of all medical staff in the trauma orthopedic department, the blood supply of the severed palm was maintained well, and the wound healing was satisfactory. It was confirmed that the replantation of the severed palm was successful. Mr. Yang and his family members also wore long lost smiles on their faces.
According to Chen Aimin, "replantation of severed palms is a complex and difficult treatment in microsurgery. After the palm is severed, it is often not a simple end-to-end anastomosis, especially when the middle part of the palm is detached, and both the deep and superficial palmar arches are damaged. The anastomosis form must be properly arranged, and the blood supply and sensory function of each finger must be taken into consideration. This requires doctors to have excellent skills and meticulous sensitivity, as well as rich anatomical knowledge and experience in limb replantation.". Especially compression induced limb injury is the most serious injury to the limbs. To achieve successful replantation surgery and good postoperative recovery of limb function, good microsurgical techniques and comprehensive concepts are needed. However, Shanghai has always been in a leading position domestically in this regard. As early as 1960, Professor Tu Kaiyuan, a renowned medical educator and one of the founders of modern trauma surgery in China, began research on amputated limb replantation and completed the world's first amputated limb replantation surgery for dogs, laying a solid animal experimental foundation for China's first human forearm amputation limb replantation surgery in 1963, and also keeping China at the forefront of the world in this field.
