MindMap Gallery Surgery 060 Hand Injury and Replantation of Amputated Limbs (Finger)
Surgery 060 Mind map of hand trauma and replantation of amputated limbs (finger), including hand trauma, replantation of amputated limbs (finger), and microsurgical techniques.
Edited at 2024-04-06 02:46:55This is a flowchart illustrating the process of archiving monthly failure analysis reports and tracking the implementation of improvement measures. The diagram is structured into five main steps, each with specific tasks and sub-tasks.Monthly Report Collection & Organization: This step involves collecting failure analysis reports from various departments, reviewing them for completeness, and categorizing them by product, failure mode, and severity. Root Cause Analysis & Statistics: Here, the focus is on categorizing causes, analyzing trends, identifying root causes, and compiling statistics on high-frequency failure modes and key components. Improvement Measure Formulation & Assignment: This step includes formulating improvement measures, assigning responsibilities, and setting timelines for implementation.Measure Implementation Tracking & Verification: It involves tracking the progress of implementation, verifying effectiveness, and confirming issue closure.Knowledge Base Update & Monthly Report Output: The final step covers archiving reports, updating the knowledge base, and compiling monthly summaries.This template can be easily reused and adapted using tools like EdrawMind to suit different organizational needs.
This is a timeline infographic detailing the annual product certification acquisition countdown process, structured into four sequential phases. The first phase, Certification Planning & Initiation, encompasses goal setting, timeline planning, resource preparation, defining specific certification objectives such as CCC/CE/FCC, formulating an annual plan with key milestones, and allocating necessary budget, personnel, and sample resources. Following this, the Application & Testing Phase involves material submission, coordination with certification agencies, core testing procedures, preparation of technical documents, application forms, and samples, selection of the appropriate certification agency, and execution of critical safety, EMC, and RF tests. The subsequent Rectification & Acquisition Phase focuses on addressing and rectifying any identified issues, re-verification processes, acquisition of the certificate, analysis of test issues, implementation of necessary fixes, and modification of samples for supplemental testing. Finally, the Countdown Monitoring phase emphasizes tracking progress, managing risks, monitoring remaining days and key milestones, managing time, technical, and cost risks, and maintaining effective internal and external communication throughout the process. This comprehensive template can be readily reused and adapted using tools like EdrawMind to meet diverse organizational requirements.
This is a flowchart detailing the weekly update and review plan for technical documents. The process is divided into six main stages, each with specific tasks and responsibilities. It begins with Weekly Planning, where the document scope is defined, update objectives are set, and schedules are arranged. Next, Document Updates involve maintaining various documents such as hardware design documents, test specifications, and BOM tables, alongside version control and archiving. Internal Review Preparation follows, focusing on compiling review materials, identifying participants, and setting agendas. The Review Meeting stage includes document examination, problem discussion, decision recording, and responsibility allocation. After the meeting, Review Feedback Processing takes place, involving issue tracking, document modification, quality checks, and closure verification. Finally, Output Deliverables are prepared, including official release versions, release notifications, review reports, and plans for the next week. This structured approach ensures systematic and efficient management of technical documents, and the template can be easily adapted using tools like EdrawMind.
This is a flowchart illustrating the process of archiving monthly failure analysis reports and tracking the implementation of improvement measures. The diagram is structured into five main steps, each with specific tasks and sub-tasks.Monthly Report Collection & Organization: This step involves collecting failure analysis reports from various departments, reviewing them for completeness, and categorizing them by product, failure mode, and severity. Root Cause Analysis & Statistics: Here, the focus is on categorizing causes, analyzing trends, identifying root causes, and compiling statistics on high-frequency failure modes and key components. Improvement Measure Formulation & Assignment: This step includes formulating improvement measures, assigning responsibilities, and setting timelines for implementation.Measure Implementation Tracking & Verification: It involves tracking the progress of implementation, verifying effectiveness, and confirming issue closure.Knowledge Base Update & Monthly Report Output: The final step covers archiving reports, updating the knowledge base, and compiling monthly summaries.This template can be easily reused and adapted using tools like EdrawMind to suit different organizational needs.
This is a timeline infographic detailing the annual product certification acquisition countdown process, structured into four sequential phases. The first phase, Certification Planning & Initiation, encompasses goal setting, timeline planning, resource preparation, defining specific certification objectives such as CCC/CE/FCC, formulating an annual plan with key milestones, and allocating necessary budget, personnel, and sample resources. Following this, the Application & Testing Phase involves material submission, coordination with certification agencies, core testing procedures, preparation of technical documents, application forms, and samples, selection of the appropriate certification agency, and execution of critical safety, EMC, and RF tests. The subsequent Rectification & Acquisition Phase focuses on addressing and rectifying any identified issues, re-verification processes, acquisition of the certificate, analysis of test issues, implementation of necessary fixes, and modification of samples for supplemental testing. Finally, the Countdown Monitoring phase emphasizes tracking progress, managing risks, monitoring remaining days and key milestones, managing time, technical, and cost risks, and maintaining effective internal and external communication throughout the process. This comprehensive template can be readily reused and adapted using tools like EdrawMind to meet diverse organizational requirements.
This is a flowchart detailing the weekly update and review plan for technical documents. The process is divided into six main stages, each with specific tasks and responsibilities. It begins with Weekly Planning, where the document scope is defined, update objectives are set, and schedules are arranged. Next, Document Updates involve maintaining various documents such as hardware design documents, test specifications, and BOM tables, alongside version control and archiving. Internal Review Preparation follows, focusing on compiling review materials, identifying participants, and setting agendas. The Review Meeting stage includes document examination, problem discussion, decision recording, and responsibility allocation. After the meeting, Review Feedback Processing takes place, involving issue tracking, document modification, quality checks, and closure verification. Finally, Output Deliverables are prepared, including official release versions, release notifications, review reports, and plans for the next week. This structured approach ensures systematic and efficient management of technical documents, and the template can be easily adapted using tools like EdrawMind.
Surgery 060 Hand Injury and Replantation of Amputated Limbs (Finger)
Section 1 Hand Injury
1. Applied Anatomy
Normal hand postures include resting position and functional position.
The resting position of the hand is when the tension of the intrinsic muscles, extrinsic muscles, joint capsules, and ligaments of the hand are in relative balance, that is, the hand is naturally still.
It manifests as wrist joint dorsiflexion of 10° to 15° and mild ulnar deviation;
In the semi-flexed position of the metacarpophalangeal joints and interphalangeal joints, the distance from the index finger to the little finger, the pad of the finger, and the palm becomes smaller and smaller, and the extension lines of the axis of each finger intersect at the carpal navicular tubercle;
The thumb is slightly abducted, with the fingertip facing the radial side of the distal interphalangeal joint of the index finger.
Its clinical significance is that when the tendon is injured, the resting position of the hand will change.
The functional position of the hand is the preparatory position when the hand will function, which is like holding a ball.
The symptoms include dorsiflexion of the wrist joint at 20° to 25° and slight ulnar deviation; the thumb is abducted and externally rotated in an opposable position with the other fingers, and its metacarpophalangeal and interphalangeal joints are slightly flexed;
The remaining fingers are slightly separated, with the metacarpophalangeal and proximal interphalangeal joints in a semi-flexed position, the distal interphalangeal joints are slightly flexed, and the degree of flexion of each finger joint is relatively consistent.
Its clinical significance lies in the fact that after severe hand trauma, especially if it is expected that the joint function will be difficult to return to normal in the future, or even ankylosis will occur, fixation in this position can maintain the maximum function of the injured hand.
hand rest position
hand function
2.Causes and characteristics of injury
(1) stabbing
Caused by pointed and sharp objects, such as nails, needles, bamboo sticks, etc. It is characterized by small wounds, which can reach deep tissues, and can introduce pollutants to cause infection. It can cause damage to nerves and blood vessels. It is easy to miss diagnosis and should be taken seriously.
(2) Cutting injury
Such as knives, glass, electric saws, etc. The wound is relatively uniform and the contamination is light. If the wound is too deep, it can cause the rupture of blood vessels, nerves, tendons, and in severe cases, the loss of fingers and hands.
(3) Blunt force injury
Caused by hammer blows or heavy objects. The skin can be split or torn off, and nerves, tendons, and blood vessels can be damaged. In severe cases, the hand can be damaged.
(4) Crush injury
Different injuring objects have different manifestations. For example, compression of doors and windows can cause injuries such as subungual hematoma, nail bed rupture, and distal phalanx fractures. If wheels and machine rollers squeeze, it can cause extensive skin avulsion or degloving injuries, combined with deep tissue damage, multiple fractures, and even destruction.
(5) Firearm injuries
Caused by detonators, firecrackers and guns. The nature of damage is high speed, explosion, and burning. The wounds are diverse, have severe tissue damage, are heavily contaminated, have a lot of necrotic tissue, and are prone to infection.
3. Inspection and diagnosis
(1) Skin damage examination
(2) Examination of tendon injuries
(3) Examination of nerve damage
(4) Examination of vascular injuries
(5) Examination of bone and joint injuries
extensor tendon test
(1) Rupture of the proximal extensor tendon on the dorsal side of the metacarpophalangeal joint
(2) Rupture of the dorsal extensor tendon of the proximal phalanx
(3) Rupture of the dorsal extensor tendon of the middle phalanx
flexor tendon test
(1) Digital flexor profundus tendon examination method
(2) Digital flexor superficialis tendon examination method
(3) Rupture of the deep and superficial digital flexor tendons
(4) Rupture of the flexor digitorum profundus tendon
Distribution of sensory nerves in the hand
4. On-site first aid
(1) Stop bleeding
(2) Wound dressing
(3) Partial fixation
(4) Rapid transfer
Internal fixation and mini-external fixation for metacarpophalangeal fractures
5. Treatment principles
(1) Early and thorough debridement
(2) Tissue repair
(3) Primary wound closure
(4) Postoperative treatment
tendon suturing
Section 2 Replantation of Amputated Limbs (Finger)
1. Development and definition
In 1963, my country's Chen Zhongwei and others first reported the success of limb replantation, and in 1965 they successfully carried out digital replantation.
Today, the technology of replantation of amputated limbs (finger) is quite mature and has been widely carried out at home and abroad. Our country has made a series of breakthroughs and has long been in the leading position in the world.
Complete amputated limb (finger): The limb (finger) is severed due to trauma. There is no connection of any tissue or although there is injured and deactivated tissue, it must be removed during debridement. This is called complete amputation of limb (finger).
Incomplete limb amputation (finger): Where the cross section of the injured limb (finger) has major blood vessel rupture combined with fracture and dislocation, the soft tissue connected to the injured limb cross section is less than 1/4 of the total section, and the connected skin of the injured finger cross section does not exceed the circumference. 1/8, there is no anastomosis of blood vessels, and necrosis will occur at the distal end of the injured limb (finger), which is called incomplete amputated limb (finger).
2. First aid for broken limbs (finger)
Principle: including hemostasis, bandaging, immobilization, separation and preservation of severed limbs (finger), and rapid transport.
Same as first aid treatment for hand injuries.
How to preserve severed hands
3. Principles of replantation surgery for amputated limbs (finger)
(1) Thorough debridement
(2) Trim and reconstruct the bone scaffold
(3) Suturing muscles (muscles) and tendons
(4) Reestablish blood circulation
(5) Suture the nerve
(6) Close the wound
(7) Bandaging
4. Postoperative treatment after replantation of severed limbs
(1) General care
(2) Closely observe systemic reactions
(3) Regularly observe the blood circulation of the replanted limb (finger), and promptly detect and deal with vascular crises
(4) Prevent vasospasm and anti-blood coagulation treatment
(5) Antibiotic application
(6) Rehabilitation treatment of replanted limb (finger)
Section 3 Microsurgery Techniques
1. Development and definition
Microsurgery is a surgical technique that uses special and fine instruments and materials to perform tiny repairs and reconstructions of fine tissues under surgical magnifying glasses and operating microscopes.
It is characterized by small tissue trauma and high surgical quality, which expands the scope of surgery and enables operations that were previously impossible to the naked eye.
After half a century of development, it has been widely used in various surgical specialties, such as hand surgery, orthopedics, neurosurgery, plastic surgery, etc.
Double binocular surgical microscope
Lens type surgical magnifying glass
2.Microsurgical instruments
Including microvascular forceps, tweezers, scissors, needle holders, blood vessel clamps, closing devices, flushing flat needles, etc. The most commonly used microscopic instruments are:
① Tweezers: Used to extract and separate fine tissues and tie sutures, so the tweezers are required to be sharp, well aligned, and have clamping force without cutting.
②Scissors: Used to separate trimmed tissue and trim threads.
③Needle holder: The occlusal surface is smooth and toothless, has a suitable width, and can firmly hold thin microscopic suture needles and threads.
④Vascular clamps: There are various vascular clamps suitable for different diameters of blood vessels, which are required to block the blood flow without damaging the blood vessel wall.
microsurgery instruments
Vascular debridement and adventitial resection
Two fixed point blood vessel suturing method