The accident happened in a 19-year-old girl’s play fighting with her friends. The ring on her left middle finger was pulled with a strong force, ripping away the skin and tissue all of a sudden. The ring avulsion caused a severe degloving injury of her finger. After the patient was rushed to Shanghai Sixth People's Hospital, doctors noticed that her finger was only left with exposed bone. Just like taking off a glove from the hand, the skin and soft tissues of the entire finger (including nerves, blood vessels, and nail beds) were all peeled off.
Doctors tried their best to rescue this young girl's promising future. Faced with the exposed bone caused by severe injuries, orthopedic experts from Shanghai Sixth People's Hospital conducted multiple consultations on repairing and reconstruction plans. 7cm full-length finger reconstruction should consider complex factors such as the external image and the internal blood supply, nerve sensory, and tendon function. After preoperative discussion and preparation, Zhou Zhengbing, the surgeon, finally decided to select the right foot nail flap and flap of the dorsum of the foot as donors to restore the middle finger. At the same time, the superficial circumflex iliac perforator flap from the ilioinguinal area was used to restore the donor area of the foot. The five toes were completely preserved, minimizing the damage to the donor area while reconstructing the injured finger.
During the 13-hour operation, the determining factor was the high-quality vascular anastomosis. "Three arteries and veins with a thickness of only 0.3 mm respectively were sutured with five stitches under a microscope with silk threads that are almost invisible to the naked eye, so as to restore blood circulation,” said Zhou. The girl's injured finger has recovered in flesh and blood and its mobility has improved significantly after rehabilitation.
The Department of Orthopedics of Shanghai Sixth People's Hospital, the cradle of replantation of severed limbs in China, restored the girl's yearning for life. On January 2, 1963, the world's first operation of severed limb replantation was successfully completed in Shanghai Sixth People's Hospital. Encountering a young worker named Wang Cunbai whose right hand was completely cut off, Doctor Chen Zhongwei led the team to complete the world's first amputated limb replantation after eight hours of hard work. Since then, China has started to develop rapidly in the field of microsurgery. Over the past 60 years, the Department of Orthopedics of the Shanghai Sixth People's Hospital has always regarded amputated limb replantation and microsurgery as traditional skills in the development of disciplines, while constantly innovating and striving for excellence.
“We are able to carry out 0.2 mm blood vessel grafting and anastomosis, which means that ultramicro surgery that could not be done before can be done now,” said Professor Zhang Changqing, vice president of Shanghai Sixth People's Hospital and a pacemaker in the orthopedics discipline. Zhang declared that with the progress in new age, work-related injuries have been greatly reduced, but accidental injuries ranging from car accidents to ring avulsion continue to occur. Limb salvage is a once-in-a-lifetime opportunity for patients and every single operation may affect their life-long happiness. This fact drives doctors to continuously pursue technological progress. "Initially, we aimed to solely restore and reconstruct the labor function of the patient. Later, the concept of 'holism’ enabled us to restore the patient's appearance. Today, the principle of 'integrating body and mind’ guides us in reconstructing the patient's hope for life," said Zhang.
At present, Shanghai Sixth People's Hospital performs more than 1,000 cases of replantation of severed limbs every year, with a success rate of over 95%. The limb salvage team of the Department of Orthopedics of Shanghai Sixth People's Hospital has diagnosed and treated more than 20,000 patients, increasing the limb salvage rate from 32.43% to 64.43%. The team has created a series of new limb salvage technologies such as cross-bridge flap transplantation, new combined flap transplantation, and residual limb flap transplantation, making a huge leap in the international level of limb salvage. The Orthopedics Department of Shanghai Sixth People's Hospital is also known as “the largest replantation center in the world” due to a large number of patients, the rich variety of cases, the high level of technology, and the large scale of the department.
Today, the Department of Orthopedics of Shanghai Sixth People's Hospital continues to grow and improve on the basis of legacy and self-development. The Department has formed a major orthopedics department at the "aircraft carrier" level, with eight majors and 12 sub-disciplines including repairing and reconstruction (amputation wards included), trauma, joints, arthroscopy, spine, bone tumors, pediatrics, foot and ankle, etc. They are among the top in China. In addition, the Department remains at the international level in the capability to diagnose difficult diseases. This is shown in its seven international technologies including surgical treatment of femoral head and osteonecrosis, limb salvage treatment of severe and complex limb injuries, and surgical treatment of tibial plateau fractures.
Zhang Changqing said that with the approval of the National Center of Orthopedics, the Department of Orthopedics of Shanghai Sixth People’s Hospital will continue to comprehensively develop the discipline of orthopedics, strengthen personnel training, and coordinate regional development to benefit more patients and bring more glories of "China Hand".
