血管吻合的胸脐皮瓣修复下肢巨大软组织缺损的护理.docVIP

血管吻合的胸脐皮瓣修复下肢巨大软组织缺损的护理 摘要：目的 探讨吻合血管的胸脐皮瓣修复下肢巨大软组织缺损围手术期的护理方法。方法 对23例下肢大面积皮肤软组织损伤行脐旁皮瓣带蒂转移移植术，并在围手术期给予心理护理、健康教育，病情观察及功能康复指导。结果： 23例患者除2例出现静脉回流障碍，经及时治疗与精心护理，均痊愈出院。结论：对下肢巨大软组织缺损胸脐皮瓣带蒂血管吻合修复术患者给予严密观察，及早发现和处理皮瓣术后血运障碍是手术成功的关键。 关键词：胸脐皮瓣；下肢；软组织缺损；血液循环；围术期护理 Abstract Objective: To explore the perioperative nersing methods in the treatment of large area defects of skin and soft tissue of lower extremity repaired by thoraco-bumbilical pedicle flaps. Methods:23 cases of the large soft tissue defects on the lower extremity were repared with vascular thoraco-bumbilical flaps. The careful perioperative nersing care, health education, close observation and functional fehabilitation guidance were given to the patients.Rescults: All patients were cured; two of them were given timely treatment and careful nursing care because of venous reflux disorder and were finally cured. Conclusin: Close observation,early detection and treatment of blood supply obstacle is the key to success of the operation in the treatmen of large area defects of skin and soft tissue of hand repaired by thoraco-bumbilical pedicle flaps. Key words thoraco-bumbilical flaps; lower extremity; soft tissue defect;blood circulation; perioperative nersing. 随着显微外科技术的不断提高，游离皮瓣技术的运用也越来越广，特别是胸脐皮瓣具有部位隐蔽又不牺牲肢体主干血管，血管蒂较长的特点[1]，已成为软组织缺损的首选皮瓣之一。术后高质量的护理措施是皮瓣成活的重要保证，我科自2005-2008年共行吻合血管的胸脐皮瓣修复下肢巨大软组织缺损23例，取得良好疗效，现将护理措施总结如下。 1 临床资料 1.1 一般资料 本组共23例，男性19例，女性4例，年龄17-51岁，平均33.5岁。致伤原因：道路交通伤11例，挤压伤7例，电击伤瘢痕挛缩3例，烧伤2例。手术时间：急诊修复15例，择期修复8例。修复部位：胫前14例，足背6例。皮瓣移植后供区直接缝合者20例，供区植皮者3例。移植皮瓣与患侧胫前动、静脉吻合者16例，与胫前动脉 ，小隐静脉吻合 5例，与胫后动、静脉吻合2例。 1.2手术方法 ①先行抗休克治疗，全身情况稳定后行急诊清创术。全身条件差或患肢局部皮肤坏死界限不明显，不必强求急诊皮瓣手术，可择其再行手术治疗。②麻醉后上气囊止血带，彻底清创、清除污物及坏死组织，骨折予以内固定，断裂肌肉与以修复。③近端局部游离出胫前、胫后动脉、静脉或足背动脉静脉备用。③取胸脐皮瓣，采用腹直肌联合的胸脐皮瓣。以脐和肩胛下角的连线为轴线作长斜形标记，先在脐外下方约3cm处至腹股沟韧带内2/5与外3/5的交点作切口，游离腹壁下血管，向上游离时包括部分腹直肌，再由皮瓣远端自深筋膜深层向脐部游离。皮瓣切取面积7cm×11cm-23cm×42cm。④游离皮瓣断蒂后将皮瓣移植与创面，并行血管吻合。 术后常规应用抗炎、抗凝、抗感染治疗1周 ，患肢抬高并用烤灯照射保暖。 2、结果 经随访2-36月，23例皮瓣全部成活，质地良好、外观满意。患指骨折恢复良好，膝踝关节功能无明显障碍，功能恢复满意。2例皮瓣远端部分坏死，予以换