Chinese medicine treatment of finger amputation and TCM diagnosis prescription prescription _

 The article Reprinted from Medical Full line:

Chinese medicine treatment of finger amputation and TCM diagnostic methods _ prescription prescription


the names of diseases (English) severed extremity and severed finger
Pinyin DUANZHIHEDUANZHI
Classification of Diseases code alias Western
trauma, limb surgical disease,
Chinese Classification of Diseases code
Western disease name defined physical trauma or surgery because of complete or incomplete break away from the , must match to survive artery, called the limb. with the surgical method in situ limb reconnected or limb, said limb replantation. replantation of limb position by change are known as replantation of limbs shift . with the surgical method to break away from the body and then transplanted to another site who said limb transplantation. broken limbs completely isolated, without any organization or only a very small amount of tissue damage associated with the subject, but in the debridement must be this cut off some of those organizations, said the complete break away from the body. Limbs of the section of fracture or dislocation, residual soft tissue connected to a quarter less than the total cross section, the main blood vessel rupture or thrombosis, the distal part of the body without the blood circulation or severe ischemia, blood vessels will cause the body does not take necrosis, said breaking away from the physical failure. metacarpophalangeal joint from distal amputation, called finger. but because of its unique anatomy, even if only part of the skin is connected, not Vascular access is often also survive. so that the section only tendon damage linked to skin residue of not more than one-eighth of the perimeter, and the remaining tissue, including blood vessels are broken finger in the distal part of the free circulation or severe ischemia, not receive blood vessels will cause necrosis of the fingers are known as incomplete finger.
Release Name
Western medicine causes (1) Cut off from nature: mainly by the press, milling machine, cutter, knife , glass and other sharp result. These injuries more common in the upper limb. (2) Roll of detachment: more from the train wheels, car wheel or injured by a blunt object such as machine gear. (3) extrusion of detachment from: this is by the heavy machinery, stone, iron or other heavy objects due to compression. (4) tear off from the: physical damage by a continuous rotation of the machine can be induced into a tear-off from.
Chinese
cause
season
region intensity and spread among
incidence

TCM pathogenesis
;
pathology pathophysiology


Traditional Chinese Medicine diagnostic criteria Diagnostic criteria diagnostic

Western Western disease diagnosis based on
;

signs symptoms history
the type of amputation following four
(1) cut off from nature: These injuries are more common in the upper limb. break away from the limb bones, nerves , blood vessels, muscle, skin and other parts of organizations have cut off in the same plane, near the cross section less tissue damage, the higher the success rate of replantation.
(2) Roll of detachment from: Roll into the wounds caused mostly complete amputation, but may still ring still attached to the skin appears, in fact, has been rolled very thin. in the debridement, the organization will lose its vitality in this part must be removed.
(3) squeezing off from: off the plane from the irregular, severe tissue damage, often a large number of foreign bodies and organizations to squeeze into the gap in cross-section, not easy to go to the net.
(4) tear off from: the machine body by continuous rotation into a tear can cause damage breaking away from cracking. section quite irregular, severe skin avulsion. muscle tendon and muscle belly often torn off at the junction. replantation surgery, if applied anticoagulant drugs, would cause extensive hemolysis and hematoma formation. tearing off limbs from, break away from the blood vessels in the distance segment, often have severe vascular spasm, to bring the reconstruction of blood circulation difficult.
medical
Electrodiagnosis
Diagnostic Imaging

laboratory diagnosis of urinary

stool blood cerebrospinal fluid
other diagnostic

Immunology
histology in the differential diagnosis of

Western identification card in Traditional Chinese Medicine evaluation standard

limb replantation prognosis indication of relief (1) limb replantation , the result of vasospasm or thrombosis and other circulatory disorders occur because, despite efforts to signs of limb necrosis has occurred can not be saved, should be free. (2) due to ischemic time is too long, muscle and other tissues in this extensive bad , liquefaction, bone, nerve and other important organizations, exposure, difficult to heal wounds, even after long and repeated surgical dressing, a record which may heal, but the functions are difficult to restore. While there may be physical survival, they may consider relief. ( 3) infection at the limb replantation, liquefaction necrosis, vascular anastomosis soaked in pus, leading to vessel wall necrosis, bleeding. (4), limb replantation of serious infection, despite aggressive treatment, they can not control, sepsis or in patients with life-threatening viral myocarditis, shall be free. (5) a long time due to ischemic limb replantation, or subject to serious injury, poor blood circulation or muscle limb replantation of extensive necrosis, resulting in acute renal failure, the no improvement after active treatment, should be free.
Western medicine treatment of complications
1, amputation of the first aid
(1) first aid: If the machine body is involved, should immediately stop operation of the machine, the machine apart, carrying the wounded down, that means the machine can not be removed by reversing the wounded. stump for the loss of limbs, extra clean dressing should be bandaged. as completely broken away from the contraction of blood vessels, is generally not a continued bleeding, not the best tourniquet. If you must apply, shall be 1 hour to relax. loose, use your fingers to suppress artery proximal side to reduce the bleeding. For most of the break away from the body, in Application of splint the injured limb before transporting to avoid damage in transit increased. completely broken away from the body, where necessary, timely and stored in low temperature environment. general use sterile or clean dressing wrapped limbs, plus a plastic bag or blanket wrapped , crushed ice or ice packs placed around to slow down the degeneration of tissue metabolism and prevent the reproduction of bacteria. taking care not to make ice water intrusion limb wounds or vascular cavity, or the amputation of limbs due to cold or freezing. off body must not be placed away from the low permeability, high permeability, or solidified liquid and disinfectant.
(2) Shipping: The first aid treatment as soon as possible the patients were transferred together with the breaking away from the conditions for replantation of limbs hospital. If patients with severe shock or visceral injury, first in time or immediately sent to the nearest hospital for emergency treatment. transfer should be selected as the fastest means of transport. transferred to the former, but also with the medical unit links in order to make the necessary preparations, is conducive to the conduct of rescue work.
2, the indications
replanted in accordance with prior knowledge of replantation should have the following basic requirements:
① patients with systemic circumstances permit, to accept the replantation. ② break away from the body have a certain integrity. ③ replantation of a certain time limit. generally the case at room temperature 20 ℃, full 6-10h after ischemia, a variety of breaking away from the body organizations, have taken place will not be back to the inverse of variability, even if the blood circulation restored, the body still can not help but necrosis. but in the cold season, breaking away from the slow degeneration of body tissues, even if the replanted over time 6h, as long as a good first aid treatment and replanting after surgery, can still be alive. before the death of the organization had not given in the cold, high pressure oxygen and other measures to extend the time limit for replantation. ischemia 36h clinical replantation of limbs have also been successful. ④ restore a functional limb replantation possible, if the body of the function adverse Jieshang Qu, should not be replanted. such as the leg was crushed, only the foot connected to the distal femur, although may be connected live, but to the prosthesis difficult. break away from the major nerve damage was extensive limb, the current lack of effective repair method, even if the replanted limb survival after, and no function.
3, limb replantation techniques points
(1) debridement: the saving time, should generally be divided into two groups debridement at the same time, a group dealing with proximal limb stump; another group dealing with breaking away from the body. two doctors in the process of debridement of all parts of the organization should be wound trauma case, removal of the length of time to exchange information and to facilitate the further design and replantation implementation. most of the break away from the body, although not connected to a lot of soft tissue, should also pay attention to retention. as long as the health of the organization, must not be arbitrarily cut off. For breaking away from the physical damage of the vascular bed, available from the main artery of heparin saline injected into the fracture. If flushing resistance, venous outflow of liquid is small; or flushing liquid leaking from the rupture, causing local tissue was expansion or a diffuse swelling, the prompt may be blocked or ruptured blood vessels.
(2) bone fixation: bone repair scaffolds is the first step in replantation surgery. According to the soft tissue of the joint case, removal of part of the bone ends, the general shorten the bone ends were taken after fixation. fixation method to easily and quickly, the precise stable, convenient healing.
(3) the reconstruction of blood circulation: vascular checks and debridement: anastomosis of small blood vessels before the major blood vessels should further detailed examination of the situation. is a sign of vascular injury in the vessel wall hematoma exists; endometrial rough, broken, closely adhesion thrombus, or wall of separation, there lining the blood vessels when injected into the liquid expansion and so on. the removal of vascular damage, should be carefully examined under the microscope in the surgery of vascular lumen of the fracture and whether the mouth of the intimal smooth and complete. intimal injury, if any, should continue to remove some, until smooth and complete lining up. limb replantation arterial blood vessel anastomosis should be made to balance supply and venous return, such as loss of balance between the two would lead to limb blood circulation disorder, affecting the survival of replanted limbs.
(4) muscle and tendon suture: Early repair of a help to initiate the joint physical exercise, early resumption of limb function, is also beneficial to fracture healing. If you find a muscle nerve dominated damage, and estimates can not be later restorers should consider the removal of the muscle. This can reduce the fascial space within the organization, so as to reduce the swelling after surgery. less important function of the muscles can not be sutured. for body contusion severe limb ischemia in a long time, or the edge of the deep fascia vascular compression is possible, should be along the body longitudinal incision of the deep fascia.
(5) nerve repair: the limb, early nerve repair, while revealing more clearly; the other hand, can also be shortened by means of bone, the nerve ends in the case of no good tension on the joint, too late for the diversion of nerve convenience. Therefore, in general, nerve repair should strive as much as possible at one time in replantation surgery.
(6) skin coverage: should seek a closed wound. neat cuts, skin suture circle around a limb, should be routine for a few of the original wound into a 60 scar contracture-like epilepsy. with skin defect, needed to cover thickness skin graft wounds.
4, the main points of replantation techniques
(1) debridement: the removal of tissue and loss of viability , to be carefully separated and accurately labeled F in the skin tissue retraction in the vein to prepare stitched.
(2) the repair of bone support: general application lmm diameter stainless steel pin for intramedullary fixation or cross-fixation. After breaking away from the joint, functional spaces for arthrodesis. bone fixed, should be on both sides of the periosteum and flexor sheath attached
health organizations at the combined suture. This prevents the reverse side of bone fracture healing and help .
(3) the tendon suture: extensor tendon are doing a suture. Near section break away, it shall also suture the extensor tendon central and side beams; side tendon suture in the beam section of the extension department. previous general do not do early flexor tendon repair, suturing the tendon sheath only until after the line of fracture healing of free tendon graft. In recent years, also used a suture. the debridement of the left when the suture in the tendon stump to win over, so that tendon to be good for co-ligation can be. This method can avoid re-operation, and to early exercise, get a good functional recovery. means for breaking away from the superficial flexor bit flat at the distal attachment of who may be refers to the deep flexor tendon distal to do tenodesis.
(4) the reconstruction of blood circulation: stitched vessels, should an intravenous injection of heparin per kilogram of body weight lmg, to prevent small blood vessels in the seam, due to a temporary stop off blood flow caused by thrombosis of small blood vessels. But in the application of heparin, they must exclude visceral injury, severe liver disease and blood diseases, etc., otherwise it would cause serious consequences, even life-threatening. fingers debridement and suturing of blood vessels should be under the operating microscope. magnification should be at about 10 times.
(5) nerve suture: in the case of tension-free, just stitch the outer membrane of a nerve volar to 2-3 pin.
(6) of the skin suture: Request for cooperation to achieve accurate, should not be too tight seam too close to avoid vascular oppression. in order to prevent future occurrence of circular scar contracture, can be means the side of the longitudinal extension of the incision, as long as not exposed to the arteries stitched, you can not be sutured. lack of application of skin graft skin wounds covered.
5, limb (finger) in the postoperative management of replantation should be noted
observe the situation of systemic and local blood circulation; rational use of anti-spasm and anticoagulant drugs; prevention and treatment of limb replantation
swelling and postoperative infection were to be important.
(1) general condition of the observation and treatment: physical detachment can be combined with other organ injuries, even a simple break away from the body, but also enough to cause systemic reactions or even life-threatening. Therefore, the general condition of patients after the observation is extremely important. ① hypovolemia: broken limbs again plant patients with blood loss, due to break away from the plane and depends on the nature. plane the higher the blood loss was also more. According to statistics, broken away from the body completely or most of the patients in the replantation of the blood transfusion the day of surgery, thigh breaking away from the average 7 500ml, leg broken away from the average 4500ml, ankle breaking away from the average 2 040ml, arm broken away from at least about 1500ml, up by over 10 800ml, an average of 4 000ml. forearm off from the average 3 300ml wrist and palm off from the average 2 100ml. so I can break away from the plane according to initial estimates, input whole blood. and after close observation of the pulse and blood pressure in patients, maintaining systolic blood pressure 13.3kPa (100mmHg) above. If declined to be identified the causes, such as hypovolemia, it is timely transfusion. the determination of central venous pressure, severe trauma complicated by shock on blood volume estimates are important. normal central venous pressure was 1.47kPa (10-15cmH2O), serious patient trauma and blood loss, the central venous pressure can be reduced to zero. transfusion, central venous pressure that is picked up. may need to repeat the clinical determination as the basis for regulating the speed of blood infusion. In addition, the determination of the proportion of plasma, peripheral blood of inspection and the application of radionuclide labeled 32P or s1Cr to determine the blood volume of red blood cells also have a certain value. ② acute renal failure: the amputation of limbs, such as the high shoulder, upper arm or thigh broken away from the patients, injury severity, prone to acute renal failure, life-threatening. cause limb acute renal failure in patients with major causes of low blood pressure, limb injury, limb ischemia in a long time, incomplete debridement, physically concurrent infections, blood vessel contraction Boost the application of drugs, if handled improperly, could soon produce acute renal failure.
acute renal failure, the urine output was significantly reduced excretion more in 400ml at less per hour than 15ml. A few patients urine though not reduced, but specific gravity was fixed in 1010, rapidly rising blood urea nitrogen and creatinine may be increased to 442-1768
μmol / L (5-20mg/dl), said that no urine, oliguric acute renal failure. At the same time accumulation of metabolic products, resulting in significant azotemia, metabolic acidosis and hyperkalemia. preventive measures to supplement the blood volume, and promptly correct the shock. physically break away from the plane is higher. interrupt the blood circulation longer who replanted the deep fascia should be cut prophylactic decompression. to avoid or reduce adverse drug application to the kidneys. Early diagnosis and early treatment. When the event of acute renal failure should be immediately restricted water, control of blood potassium disease, the lifting of acidosis and azotemia. In addition special attention should be wound infection control and prevention of toxic absorption. due to acute renal failure are self-limiting, through treatment, if security through 10-Zld, can heal itself. ③ fat embolism: rare,
but can be very serious. generally occurs in multiple injuries or long bone fracture patients. its severity varies according to the amount of fat embolism, is not more to see mild symptoms or moderate pulmonary embolism. clinically classified into three categories: l) fulminant, a partial or general convulsions, coma gradually transferred, often within 24-48h after death. Diagnosis is difficult and susceptible to error that irreversible brain damage or shock caused by .2) standard, the typical symptoms of fever, rapid heartbeat, shortness of breath, lethargy, irritability, delirium, and finally coma and may have to the brain and other neurological symptoms like stiffness group. after injury, 2-3d, chest, arms, neck and other skin thinner at the base of the skin can occur within the sediment points. where such as biopsy, showing a fat embolism. subconjunctival, eyes and mucous membranes are likely to have oropharyngeal bleeding, have been misdiagnosed as sepsis, .3) incompetence, less fat embolism, minor or atypical symptoms, so clinically difficult to find, is often considered the reaction caused by absorption of hematoma. In addition to clinical manifestations, the urine can be free fat appears; sputum examination may be larger than 10-12μm of the fat globules; in blood was free of fat droplets can be seized, and the serum lipase content increased. chest radiograph can be a snow-like shadow. electroencephalogram also may have abnormalities. trauma patients should avoid unnecessary handling, timely oxygen and anti-shock treatment is an effective measure to prevent fat embolism. loyalty with those of dextran 40 and heparin therapy.
(2) local blood circulation Observation: replanted limbs, should be closely observed for early detection of blood circulation, and identify the causes and quickly solved. If you can not detect changes in time, the hours of delay, may form irreversible degeneration of blood circulation and organizational crisis. So Special care should be replanted, careful observation and timely treatment. replanted limbs of normal blood circulation, skin and nail color red, wrinkles significantly, pulp fullness. limb elevation after 5-10min flat, should be 45-60s in red. with digital compression skin or nails, the color is pale, remove your finger within 2-3s that turned pink, indicating the normal capillary filling time. limb skin temperature at room temperature 20 ℃ environment, often more healthy limbs symmetric point of high temperature 1-2 ℃. distal arterial pulse can be significantly hit. acupuncture for finger tip or the side in 5-10mm refers to the skin incision, should keep themselves out of bright red blood. blood circulation obstacle, pale skin and nails, pulp collapse, deepening wrinkles, raise the limb when spotted, prolonged capillary filling time, pulse weakened or disappeared, the skin temperature dropped to reduce finger tip needle or incision bleeding or bleeding that blocked arteries. If purple skin and nails, pulp expansion stiff, the skin wrinkles is not obvious or disappear, raising the body does not appear spotted. capillary filling time shortened, there is the pulse, skin temperature dropped, acupuncture, bleeding fingers more color Zihei, then venous obstruction.
(3) the application of anti-spasm drugs: vasospasm in limb replantation surgery and after surgery is not uncommon, especially in finger replantation, because the small blood vessels easily spasm, occlusion of the lumen. relieve spasm of the methods include complement blood volume, local heating, hydraulic expansion of vascular spasm, cervical sympathetic ganglion of closed brachial plexus block and the application of anti-spasm drugs. many kinds of anti-convulsive drugs , there are sympathetic to relax smooth muscle spasm drugs and two types of drugs. The former, such as papaverine, Marcel Bian result, chlorpromazine, etc.; latter inositol nicotinate, Torah yl Lin, tobacco acid, Maodongqing and so on. topical application, then a 6% magnesium sulfate obvious effect.
(4) application of anticoagulant drugs: In recent years, due to the further development of microsurgery, about 1mm in diameter suture patency rate of small blood vessels close to 100% . Therefore, replantation surgery, the general application of anticoagulant therapy is no longer just before the small blood vessels in the suture intravenous heparin 1. unless individual vein severe contusion, or inadequate venous return drops to be cut as the tip of finger drainage to maintain the circulation of blood who was given heparin in the body.
(5) replantation prevention and treatment of limb swelling: the amputated limb after replantation of limbs were swelling may occur. such as limb swelling increased will be the first capillary and venous pressure, causing tissue hypoxia. venous obstruction, but also to promote increased swelling, forming a vicious cycle. replanted limb interstitial pressure and arterial pressure increased to equal, then the blood can no longer perfusion organization seriously affect the body's survival. So, pay close attention to post-operative swelling of the development of appropriate treatment for the cause.
6, limb replantation
shift two or more completely broken away from the body, such as can not be replanted in situ, can be more complete amputation stump on replanting to another, saying the shift limb replantation. translocation replantation only under certain conditions. broken limbs from the two or more of a similar nature, due to heavy damage and can not do in situ replantation, such as not to shift, then two or more limbs are lost replanting conditions, and the shift, at least one physical feature different levels of recoverable persons.
(1) the shift finger thumb replantation
functional importance, such as conditions permit, should be used as a displacement of other finger replantation, you can remove the thumb reconstruction after surgery. If the thumb side of the grinding, can not be replanted, rolling the other side of the upper limb serious injury, or nerve damage can not be repaired due to loss of replantation conditions, but the thumb or other fingers intact, it is desirable the thumb or other finger on the other side of the transplant. For other than the addition to the thumb more than one finger broken off, can also use shift replantation, reconstruction index finger and middle finger as much as possible.
(2) displacement of lower limb replantation of both lower limbs
rupture, such as serious injury, not the original line digital replantation, or the need to reduce too much, causing severe lower height after replantation who, according to the damage, the belly-off shifting more complete replantation and can play better in the longer features on the stump, and the other side of the assembled prosthesis.
(3) the shift of the upper extremity replantation replanted
conditions upper and lower extremity movement similar, but the importance of upper limb shortening than for the lower limbs, and whether nerve and muscle good repair is an important issue to consider.
7, paragraph cut limb replantation
birth to the original tumor to be a result of amputation or extensive damage to a limb amputated, and then were not violations of the distal limb replantation at the proximal end, which not only removed the lesion, but also retained a functional limb, said limb replantation cut section.
(1) cut-off limb replantation of the conditions in paragraph
① lesions in the upper limb, important because of upper limb function, limb function is poor, little body reduce the function of the time. and lower extremities, such as reduced more, the function is not as artificial limbs, lower limbs, generally not used. ② some cases can not be removed to achieve a wide range of general radical purpose, and the upper limb amputation or soft tissue tumors. ③ circular soft tissue damage, scarring, skin, nerves, blood vessels, muscle, tendon and bone and other tissue defects or extensive adhesions, distal limb function and difficult to restorers. ④ In the complete removal of lesions, based on a well-limb for distal replantation, and can restore certain functions were estimated.
(2) required surgical indications
① original line of amputation, upper limb malignancy low bone tumors, such as chondrosarcoma, giant cell tumor grade or pathological Although Ⅲ Ⅱ, but the tumor has been worn to the bone cortex and extensive infiltration of the soft organizers. ② Some can not simply local excision of soft tissue sarcoma, such as synovial sarcoma, malignant hemangioendothelioma, hemangiopericytoma, malignant peripheral nerve sheath tumors, etc.. ③ recurrence after excision and then difficult to complete local excision of bone or soft tissue tumors. ④ individual large benign tumor, such as the extensive destruction of soft tissues, not local excision or retention function, may also consider, as appropriate. ⑤ limbs due to trauma, infection and other reasons, resulting in the formation of the ring and scar tissue defect, it is difficult recovery are. ⑥ for highly malignant tumors, due to early hematogenous metastasis, the general do not advocate for this surgery. However, if patients with an urgent need to retain body parts, and there is effective with the application of drugs or other measures, but also consider, as appropriate.

Chinese medicine acupuncture treatment
;

Massage Integrative Medicine
rehabilitation care
the functional recovery of limb replantation: the recovery limb replantation replanted limb function is to carry out the purpose of evaluation is replantation is a major indicator of success.
(1) physical therapy and functional exercises: functional recovery of limb replantation is helpful. Early application can reduce swelling, relieve spasm and prevent infection. In Neural function is not restored before the body can not initiate activity, physical therapy to improve blood circulation, delayed muscle atrophy and prevent scar adhesions and reduce joint and other hard-line role. physiotherapy should be as soon as possible, to get started after surgery 1d, if active bleeding, thrombosis or severe wound infection treatment should be deferred. the lack of nerve supply of limbs, skin, nor the feeling of poor nutrition should be taken to avoid burns. scaffolds for bone reconstruction, multi-containing metal fixation, should select the appropriate therapy.
(3) Functional evaluation: to maximize the recovery of limb function should be carried out after a release at least l years later. according to the following four assessment: Ⅰ level - can restore the original work, range of motion up to 60%, and feel good, strength for the 4-5 grade; Ⅱ level - can make the appropriate work, range of motion up to 40% or more, there is the feeling of the main nerve, muscle strength is 3-4; Ⅲ level - to help daily living, range of motion up to 30% or more, there is some sense of nerves, muscle strength was grade 3; Ⅳ level - physically alive, but almost complete loss of function. As an individual patients with amputation injuries, functional recovery, nature of work vary, there is not perfect at the above criteria.
prevention
historical research as early as 1903, Hopfner the conduct of the dogleg cut off the replantation of animal experiments, but did not receive the expected results such as .1906 on the first successful replantation of Carrel a dog's hind leg was also received .1953 of a successful replantation .1960 dogleg Tu Kaiyuan, China, also conducted replantation of the dog leg completely broken away from the animal experiments, and experience success in December Soupault .1962 reported 2 cases of incomplete detachment from the upper limb replantation, 1 case of failure, l cases of poor functional recovery of .1963, China Chen Zhongwei, etc. the first report of one case of traumatic forearm complete break away from the case, after successful replantation, and restore a good function of .1962 years, Shorey and Malt were also reported 2 cases of upper limb replantation of completely breaking away from the successful cases . Since then, domestic and foreign on the complete and incomplete reports of replantation of breaking away from the beginning to see increased. So far, the number of cases reported in China as the most, and for the use of multi-access vein to reduce limb swelling, early repair neurological function as soon as possible to promote recovery with cold and hyperbaric oxygen treatment to prolong limb ischemia tolerance time, the shift replanted limbs, and cut and replanted with a section of the treatment of upper extremity malignancy has accumulated a wealth of experience .1965 years, Kleinert and other reports using microsurgical techniques almost broken thumb replantation success. In the same year, Buncke and other reports will be completely broken away from rhesus monkeys after thumb replantation success of .1967 in May, reported the Shanghai Sixth People's Hospital from 1966 on January 20 has been successful replantation of fingers .1968, Shigeo Komatsu and other reports of their success in 1965, 1 case of replantation of full cut thumb. Since then, reports on replantation gradually increased, but the number of cases were little more than survival rates of about 50% -80%. With the advances in microsurgical techniques, the survival rate of replantation greatly improved. since 1976, and more generally between 88% -94% . some of the original that can not be replanted severed fingers, such as avulsion rupture, the higher number of vascular defects, and break away from the distal fingers, also have a successful replantation.