Clinical Application of Restrictive Brace Combined with Psychological Intervention after Replantation of Severed Fingers in Children

Abstract

Objective. After replantation of severed fingers in infants, the utility model patent upper limb restrictive brace-assisted bed rest braking, combined with psychological intervention, can alleviate children’s anxiety, so as to reduce the occurrence of vascular crisis. Methods. The study period was from April 2015 to July 2018. In this paper, 30 children with finger injuries in hand surgery in the CIS electronic medical record system of Cangzhou Integrated Traditional Chinese and Western Medicine Hospital were selected as the research objects. Replantation was performed in 30 infants with severed fingers. Among them, 15 cases were applied with the method of aircraft chest arm gypsum splint combined with sedative drug braking and the utility model patented product upper limb restrictive brace fixation-assisted bed rest braking, and the method of psychological intervention was applied at the same time. Results. Among the 15 fingers in the control group, 6 had vascular crisis and 1 in the experimental group. The incidence of vascular crisis in the experimental group was lower, and the difference between the two groups was statistically significant ( P < 0.05 ). The patients were followed up for 9~18 months, with an average of 9.72 ± 1.07 months. In the control group, 15 cases of severed fingers survived, and there were 13 cases of replantation finger necrosis in 2 cases of intractable arterial crisis. In the experimental group, 14 cases of severed fingers survived in 15 cases and there was 1 case of replanted finger necrosis in intractable arterial crisis after operation. There was no significant difference in the survival rate between the two groups ( P > 0.05 ). In addition, the replanted finger function was evaluated. In the control group, 9 cases were excellent, 4 cases were good, and 1 case was fair. In the experimental group, 14 cases were excellent, 1 case was good, and 0 case was fair. The functional evaluation of the experimental group was better than that of the control group, and the difference between the two groups was statistically significant ( P < 0.05 ). Conclusion. For infants after replantation of severed fingers, the application of the utility model patented product upper limb restrictive brace can effectively make up for the insufficient fixation of aircraft chest arm gypsum splint, reduce the occurrence of vascular crisis, and assist children in bed. In addition, the application of psychological intervention can reduce children’s postoperative crying and is conducive to children’s postoperative recovery.

Outcomes of Digit Replantation in Children: A Systematic Review

“…8–28 The timeframe of patient recruitment in included studies ranged from 1973 to 2020, where 13 studies included patients who were recruited before the year 2000, 8–12,15,17,20,21,23,25,27,28 and 10 studies recruited patients who were recruited onwards of the year 2000 (Table 1). 10,13,14,16,18,19,22,24,26,27 The mean age of patients across included studies ranged from 1.3 to 11.7 years old. The proportion of male patients across included studies ranged from 46% to 87%; hence, the proportion of female patients ranged from 13% to 54%.…”

“…7 Dec postulated that this may be due to adult male patients experiencing severe mechanisms of injury associated with digit amputation more frequently, 7 whereas this difference between sexes may not occur in children. 22 3.55 Across included studies on successful pediatric digit replantations, we found that reporting of patient-reported outcomes after replantation was limited. In particular, no studies reported outcomes using the Disabilities of the Arm, Shoulder, and Hand questionnaire.…”

“…The mean time from injury to surgery across included studies ranged from approximately 3 hours to 18 hours, where the bone length of the replanted digit was shortened at least minimally across all studies (Table 3). Thirteen studies reported performing tendon repair in some digit replantation patients, 9,13,[15][16][17][19][20][21]23,24,[26][27][28] 11 studies reported performing bone fixation using a Kirschner wire, [9][10][11][12]14,[17][18][19]21,22,25 eight studies reported performing nerve repair, 9,16,17,19,24,[26][27][28] and four studies reported performing vein grafting. 9,12,21,27 With respect to anticoagulation agents, the use of intravenous heparin intraoperatively was reported in eight studies, 11,12,15,[17][18][19]21,27 the use of heparin gauze was reported in two studies, …”

“…14 No studies reported on postoperative anticoagulation. Thirteen studies reported performing venous anastomosis in some digit replantation patients, 10,12,14,15,[17][18][19]21,22,24,[26][27][28] and six studies reported performing arterial anastomosis in some digit replantation patients. 10,16,18,19,21,27 Only one study reported on artery size, recording a mean diameter of 0.4 mm.…”

“…A total of 814 digit replantation procedures were performed across our included studies, with 36 replantations reported in the thumb across 10 studies. 9,10,12,16,[18][19][20][21][22]28 Seventy-four index finger replantations were performed across 11 studies, 9,10,12,16,[18][19][20][21]24,27,28 48 middle finger replantations were performed across 10 studies, 9,10,12,16,[18][19][20]24,27,28 55 ring finger replantations were performed across 10 studies, 9,10,12,16,[18][19][20]24,27,28 and 29 little finger replantations were performed across nine studies (Table 2). 9,10,12,16,18,20,…”