游离皮瓣修复小腿及足部软组织缺损围手术期护理.docVIP

游离皮瓣修复小腿及足部软组织缺损围手术期护理 刘素曾令蓉邓上元 湖南郴州198医院湖南郴州423000 【摘要】目的：探讨加强围手术期护理对游离皮瓣修复小腿及足部软组织缺 损临床疗效的影响。方法：对28例游离皮瓣手术移植修复小腿及足部缺损病人 在围手术期通过采取系统的量化的护理方案，从心理护理、疼痛护理、术区皮瓣 护理、感染防控、营养指导等方面着手。结果：木组28例，护理过程中发生血 管危象5例，行手术探查后4例存活，1例坏死，治愈率96 42 %。结论：认 真细致做好皮瓣移植病人围手术期的护理，采取量化指标，能有效而准确的观察 术后皮瓣血供，及时发现动静脉危象，提高皮瓣存活率，促进肢体功能恢复。 【关键词】游离皮瓣;软组织缺损;围手术期护理Peri operation period nursing defect free skin flap in the repair of leg and foot soft tissue Liu SuZeng LingrongDeng Shangyuan 【Abstract】 Objective To explore the peri operation nursing method of application dissociative flap to repair the soft tissue defects of leg and foot. Methods 28 patients with dissociative flap transplantation for the repair of the lower leg and foot defects, while strengthening the peri operation nursing. Results Through the adoption of strict observation, psychological nursing, pain nursing, postoperative flap care, infection control, nutrition guidance and caring for this group of patients, 26 cases were cured, which appeared vascular crisis in 12 cases, 10 cases survival,after exploratory operation， 2 cases flap necrosis, the cure rate was 92 86%, the rate of necrosis was 7 14%. Conclusion Proper, effective preoperative psychological, postoperative right position guidance, effective infection prevention measures, strict observation of flap blood circulation, can establish the patients confidence, early detection of vascular crisis, and to take timely and effective preventive measures, can improve the survival rate of dissociative flap. 【Keywords 】Dissociative flap; Reconstruction of soft tissue defects; peri operation nursing 【中图分类号】R274 32【文献标识码】B【文章编号】 1674-8999(2013)08-0171-01 随着车祸发生外伤事故增多，造成小腿及足踝部皮肤大面积缺损、肌腱及骨 折外露等情况比较多见，治疗难度大。2010年8月~2012年12月我院收治28 例小腿及足部软组织缺损的患者，我们采用游离皮瓣手术移植修复创面，取得了 较好疗效。现将围手术期护理体会报告如下。 1临床资料 本组28例，男21例，女7例，年龄17?58岁，均为外伤所致。16例为单 纯小腿皮肤缺损，合并肌肉、肌腱及骨外露；8例为足部皮肤缺损，ii都有不同 程度的肌腱及骨外露；4例为小腿及足部的大面积皮肤缺损，合并肌腱断裂缺损、 骨外露。 28例中有25例合并不同程度的骨折，均急诊行骨折复位固定术；有12例合并 胫前、胫后血管断裂损伤，急诊行血管探查修复术。28例软组织缺损创面中奋 21例行游离股前外侧皮瓣移植术、7例