1.Overview of amputated limb (finger) reimplantation refers to the operation of reconstructing the blood circulation of the amputated limb (finger) through orthopedic and microsurgery to regenerate the limb (finger) that has lost its blood supply. (1) Classification according to the degree of limb severance: ① Complete severance. The severed limb is completely separated from the body without any tissue connection, or there is a little tissue connection on the severed limb (finger), but this part of the tissue must be cut off and replanted in the process of debridement. Incomplete severance. Although the severed distal limb (finger) has a small amount of skin and soft tissue connected to the proximal end, the main blood vessel is broken or embolized, and only anastomosis of the blood vessel can make the severed limb survive. (2) According to the nature of limb injury classification: ① neat injury. Such as sharp cutting and sawing of the severed limb, neat trauma, no serious soft tissue contusions and defects. ② untidy injury. Mostly due to mechanical stirring, stamping, rolling and strangulation, crush injuries or avulsion injuries, tissue damage is serious and extensive removal of contused tissue can still replant the limb. 2, first aid treatment (1) patient care: first of all, pay attention to the patient’s general condition, according to the mental, pulse, breathing, blood pressure, etc. to determine whether there is shock or combined cranio-cerebral, thoracic, abdominal and other important organ damage, should be the main focus of life-saving. If the limb is completely severed, the general vascular retraction can be self-occlusion, the use of pressure bandage splinting can stop bleeding, such as broken limb (finger) stump with pulsatile bleeding, the site if available, the available hemostatic forceps clamp the broken end of the vessel, but not clamp too many vessels, in order to facilitate vascular anastomosis, with a tourniquet should record the time of application, relaxed once every hour, the limb if there are multiple fractures, the affected limb should be fixed to prevent additional Keep the severed limb dry and do not soak it with any liquid. In case of large limb severance and blood loss, the limb should be quickly transferred to a hospital that is in a position to perform limb reimplantation after onsite treatment. (2) Preservation of severed limbs: severed limbs (fingers) should be preserved in cold storage, limbs wrapped in clean cloth, outside with plastic bags delicacy, placed around the ice, severed limbs (fingers) contraindicated directly immersed in ice or ice water. (3) Time limit for replantation of amputated limb (finger): It refers to the time from amputation of limb (finger) to reconstruction of blood circulation at room temperature, i.e. thermal ischemia time, thermal ischemia time generally does not exceed 6 hours, if the temperature is low or after refrigeration, the time limit is extended. Therefore, the time limit of replantation is related to the degree of limb injury, ambient temperature and preservation method. 3.Post-operative care Post-operative patients should be placed in a single ward to facilitate disinfection of the diaphragm and prevent cross infection, room temperature should be kept at 20-25℃, humidity at 60℃, room should be regularly ventilated and disinfected, ultraviolet light should be irradiated twice a day, and floor furniture should be wiped with 1:1000 Neosporin solution or 0.5-1% disinfectant spirit solution. (1) Systemic care: after a long period of trauma and surgery, the patient loses more blood, and should be supplemented with sufficient amount of whole blood during the operation; after the operation, closely observe the skin color, blood pressure, pulse and filling degree of peripheral veins of the wounded, and make preliminary judgment of whether there is anemia, and do routine laboratory tests of blood and blood cell pressure, and use central venous pressure measurement if necessary, so as to take timely measures; for high limb amputation, attention should be paid to the presence of acute (2) Localized care: The patient should be treated with a blood test. (2) Local care: ① Move the patient slowly and gently, lie flat, raise the affected limb appropriately, slightly above the level of the heart, place the replanted limb on a special small wooden table at the bedside, lay sterile towels on it, and cover it with a protective frame. ②The affected limb should be properly fixed with dressing or plaster rest, the dressing should not be too tight, the finger (toe) end should be exposed, covered with sterile towel or gauze in order to observe the blood circulation, and pay attention to prevent the injured person from moving the limb after sleeping, so that the blood vessel is pressurized and spasmed. When the arterial blood supply is insufficient, the end of the replanted limb is pale, the finger belly is deflated, the skin elasticity disappears, the wrinkles deepen, the skin temperature drops, the arterial pulsation is weakened or disappears, the capillary filling time of the nail is prolonged, and when the venous return is obstructed, the end skin is bruised and swollen, the skin blisters, the skin temperature drops, and the nail capillary filling time becomes shorter. After the appearance of blood circulation disorder, the doctor should be promptly reported; analyze the cause of the occurrence, check whether the limb is too tightly wrapped, whether the comprehensive skin tension is too large, whether there is a subcutaneous hematoma, etc. Generally, the sutures can be removed, drain the accumulated blood, reduce the tension in the limb, and at the same time give low-molecular dextrose, poppelargine, tolazurin and other coagulant antispasmodic drugs, local insulation If the limb is swollen, the limb can be elevated, wet and hot compress with 50% magnesium sulfate solution, external application of traditional Chinese medicine skin nitrate, intravenous drip of albumin, hyperbaric oxygen to improve the oxygen supply of the limb and promote venous reflux also has a good effect. ④ Regular and fixed point skin temperature measurement. Generally, the skin temperature should be measured once every hour for 10 days after surgery, and the temperature measurement should be done 15 minutes after the baking lamp is turned off to avoid errors, and the corresponding part of the healthy side of the limb should be measured at the same time when the temperature is measured and recorded. If the skin temperature is lower than that of the healthy side or suddenly drops, it indicates the presence of vascular crisis. (5) Application of baking lamp: irradiate the replanted limb with a 60-100W lamp with a distance of 33-50cm after surgery to make the local blood vessels dilate, and it usually takes about 7-10 days to use the baking lamp. (3) Application of antibiotics: Wound infection can cause bursting and bleeding of the vascular anastomosis and affect the survival of the replanted limb (finger), which can endanger the patient’s life in serious cases. The main measures to prevent infection are strict aseptic operation, thorough debridement, and preoperative and intraoperative administration of broad-spectrum antibiotics to prevent infection, and frequent culture of wound surface exudate and drug sensitivity test to suggest the application of effective antibiotics. (4) Application of anticoagulant drugs: In recent years, due to the improvement of microsurgery technology, anticoagulation therapy is generally no longer applied after finger replantation surgery. Heparin is often used as a local flushing anticoagulant when anastomosing blood vessels. 50 ml of heparin is diluted into 20 ml of 2% lidocaine and 200 ml of saline to form a solution for local flushing anticoagulation. (5) Functional recovery of the reimplanted limb (finger): Before the recovery of the nerve function of the reimplanted limb, the nurse should help to do passive activities and massage of the injured limb joints, and after the recovery of the nerve function, try to encourage the patient to do active activities, and then combine with the use of microwave irradiation, ultrasound and other physical therapy to achieve the purpose of recovering the maximum function of the injured limb.