Inguinal tubular bone and flap transposition

The flap is also called pedicle grafted skin. According to modern wisdom, a flap is a mass of tissue composed of skin and subcutaneous tissue that can be transferred from one part of the body to another. During the transfer process, one or two pedicles must be connected, or they can be temporarily disconnected, and the vascular anastomosis is performed after transplantation. The blood transport and nutrition of the flaps were completely dependent on the pedicle at an early stage. Treatment of diseases: sciatic nerve injury Indication (1) Repairing fresh wounds or old wounds with exposed tissues such as tendons, bones, joints, large blood vessels, and nerve trunks. For wounds with deep tissue (tendon, large blood vessels, nerves) defects or exposure, unstable scars close to the bone surface or scars with ulcers, in order to strengthen the thickness of local soft tissue, or for later tendon, nerves, bones, joints For the repair of tissues, flap repair should be performed. (2) Organ reconstruction: For example, the reconstruction of the nose, lips, eyelids, eyebrows, ears, penis, and fingers are based on flaps, and then combined with other supporting tissues (such as cartilage, bone, fascia, etc.). (3) Repair of the piercing defect: If the cheek hole is worn, it is often required to cover the skin with a rich blood supply. In addition, the hole defect of the bridge of the nose, the upper jaw, etc., the repair of the vaginal bladder or rectal fistula must also be performed according to the treatment principle of the tunneling defect, including the lining tissue and the covering tissue. (4) Enhance local blood supply: improve nutritional status such as radiation ulcers, hemorrhoids, etc., local nutrition is poor, wounds are difficult to heal, blood is transported through the flaps, and local nutritional status is improved. Therefore, the flaps are preferably partial axon skins. The flap or island flap does not require a pedicle surgery, which not only maintains a good blood supply to the repair area, but also has a good sensory recovery. Contraindications 1. If it is an elderly patient, it is best not to have surgery after the long-term plaster bandage is fixed, and it is estimated that the joint movement is not easy to recover completely. 2. If it is difficult to obtain cooperation due to its young age, it should be carefully considered. 3, the lower limbs of the healthy side have nerves, blood vessels, bones, joints or skin diseases, it is best not to have surgery. Preoperative preparation 1. Improve the general condition, such as patients with anemia, low plasma protein, dehydration, etc., must be treated first. 2. The granulation wound needs to be prepared for a period of time, including unobstructed drainage, diligently changing the dressing and saline wet compress (usually wet for 2 to 3 days), proper pressure dressing, raising the affected limb, waiting for the germination color to be fresh and rosy, texture Solid edema, less secretion, no inflammation around the wound edge, can be skin grafting. If the granulation tissue is high, it is feasible to remove it. 3. Fresh wounds should be treated according to the debridement steps, so that the wounds have no active bleeding and necrotic tissue, and the edges are trimmed neatly. 4. The donor site should be shaved 1 day before surgery, brushed with soapy water, wiped dry, then rubbed with alcohol, wrapped with sterile towel, can not use strong disinfectant (such as iodine, etc.), so as not to damage the epidermis, reduce The skin is vital. Skin disinfection was performed with 1:1000 thiomersal and 75% alcohol during surgery. Surgical procedure Old forearm skin and part of the humerus. X-ray films show the extent of the humeral defect. Flap design: Point: 2 cm below the inguinal ligament, femoral artery pulsation. Line: The connection between the beat point and the anterior superior iliac spine. Face: 4cm above and below the line is the width of the flap, and the proximal end is appropriately extended to the length of the flap. The flap was cut according to the design, the skin of the pedicle was not cut, and the flap was lifted from the deep fascia layer, and the rotatory motion and the vein were included in the flap. In the appropriate part of the deep surface of the flap, the bone flap is cut from the iliac crest. Be careful not to separate the flap from the bone flap. The pedicle of the flap is sutured into a skin tube. The flap donor area directly sutures the closed wound. The forearm was removed, and the two ends of the humerus were exposed to repair the stump of the bone. The tibial block was inserted into the tibial defect and fixed with a screw. The flap is sutured to the affected area. The bone graft and the tubular pedicle flap were displaced. After three weeks, the tubular flap was broken. Long arm tubular gypsum fixes the affected limb to bone healing. X-ray films showed that the bone graft had healed. Perform a functional workout. complication 1. Postoperative care of hand flap transplantation is based on postoperative care routine. 2, systemic observation: 1 blood volume observation, insufficient blood volume can make the surrounding blood vessels contract, affecting the blood supply of the transplanted flap, threatening the survival of replanted tissue, so closely observe the patient's pulse and blood pressure changes; 2 observe the amount of liquid in and out, Pay attention to maintaining the electrolyte balance to ensure the basic conditions for replantation tissue survival. 3, local observation: pay attention to observe the color of the transplanted flap, skin temperature has no edema, etc., observe whether the wound has oozing blood, pay attention to the graft flap with or without vasospasm, if there is abnormal report to the doctor in time, with the same finger replantation. 4, the limbs properly raised, can reduce limb swelling, while paying attention to the flap area to avoid compression.

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