three-flap surgery

Three-valve surgery for the repair of cleft palate. The anterior and posterior iliac mucoperiosteal flaps were used to repair the cleft palate defect. The characteristic is that the anterior iliac crest is firstly cut and turned, so that the wound faces the oral cavity, the mucous membrane faces the nasal cavity, and then the mucosal flaps of the two sides are moved back and forth to correct the defect. It has the advantage of being able to repair one side of the splitting at a time, but the soft palate is not pushed back enough, and the pronunciation is not ideal. Treating diseases: cleft palate Indication Three-valve is applied to one side of complete cleft palate. Contraindications Cases with anemia, upper respiratory tract infection, inflammation of the ear and nasal passages, and grade III enlargement of the tonsils, especially those with congenital heart malformations, should be examined and treated by the relevant department before surgery. Preoperative preparation You should make a sputum guard before surgery and try it for 1~2d to make it accustomed to eating. Those whose trailing edge is too long should be worn away to prevent nausea and vomiting. The nose was started with 0.25% chloramphenicol 2 days before surgery. Prepare blood 150 ~ 200ml. Adult patients need to be treated with oral cavity 1 to 2 days before surgery, and often contain Du Bell liquid. One hour before surgery, a proper amount of atropine was injected subcutaneously. In the morning, the patient is fasted, and the surgery is delayed. The sick child can take about 200ml of sugar water 4 hours before surgery. Surgical procedure 1. Design an I-lobe along the anterior gingival rim of one side, the width of which is sufficient to reach the opposite side and cover the opposite rim. Use the No. 15 blade to cut through the periosteum of the I valve alveolar margin, insert the periosteal separator to separate the mucoperiosteal flap and reach the edge of the fissure. Check whether the opposite edge can be covered after the flap is lifted. If not, continue to the fissure. The upper edge of the vomer surface is peeled off, and a part of the vulvar periosteum is used to widen the mucoperiosteal flap. Finally, the surface mucosa of the sacral periosteal flap was repaired, and the periosteum of the contralateral fissure was cut into about 1 to 2 mm and peeled off to the nasal side. At this time, the edge of the I-valve was sutured intermittently with the edge of the fissure with a No. 1 silk thread. The thread of the suture is buckled to the nasal side, and the formed mucosa faces the nasal side, creating a complete mucoperiosteum flap facing the oral side. 2. With the Ianganbeck method, cut the two petals of II and III, cut the wing hook, cut the aponeurosis, cut the edge of the fissure, stagger the II and III valves, and partially overlap the II and the valve. Push back slightly, and divide into 3 layers for interlacing. complication Bleeding Bleeding can occur due to injury to the aorta, sinus arteries, and surrounding small blood vessels, and blood oozes from the edge of the loosened wound. The adrenaline gauze should be filled and pressurized to stop bleeding, and an antibiotic solution containing epinephrine can be dripped from the nasal cavity. Add a hemostatic agent, open the wound if necessary, and ligature to stop bleeding. 2. Difficult breathing Often caused by intubation injury caused by laryngeal edema, can be treated with hormones and aerosol inhalation. In a few cases, severe edema of the endotracheal mucosa caused by increased dyspnea, should be used for tracheostomy. 3. The wound partially splits and perforates Because there is still some tension after suturing the mucoperiosteal, it is easy to split the perforation at the junction of hard and soft palate. It can be self-healed and repaired after half a year. 4. Partial necrosis of the mucoperiosteal flap Due to the cutting of the aorta on one side, or in the sacral reduction suture, the blood supply to the aorta is blocked, and the tip of the mucoperiosteal is partially necrotic. The dressings were exchanged day by day, the necrotic tissue was cut off, and the repair was performed half a year after healing.

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