skin grafting

Skin transplantation is the main surgical method for tissue transplantation. In addition to the general surgical basis, it is necessary to have a more familiar understanding of tissue transplantation methods. Treatment of diseases: burns, burns, chemical burns Indication A person with severe skin damage or extensive burns. Contraindications The age of the body is weak, the vital organs such as the heart and lungs are poor, and the surgery does not restore hope. Preoperative preparation Careful design before surgery, pay attention to the main blood vessel direction of the donor site, so as to establish a favorable blood circulation. Surgical procedure First, skin grafting Skin grafting is divided into thin (surface or thick skin), medium (fault or medium thick), thick (full or full thickness) depending on the thickness. . There are two ways to cut the skin: 1. The method requires a long, thin and sharp cutting knife with two blades and two wooden boards. When the skin is taken, the leather surface of the donor area remains flat and tense. The surgeon holds the knife in the right hand and holds the wooden board on the donor area in the left hand. The other assistant pulls the skin in the opposite direction with the wooden board and grips the skin on the opposite side of the donor site. Then cut into the cortex with a knife, often back to the sawing action, you can cut the desired skin. The thickness of the skin depends on the angle between the blade and the skin. The larger the angle, the thicker the skin. 2. The mechanical peeling machine uses a skin-cutting machine to take a relatively flat skin, uniform thickness and neat edges. The thickness of the skin is in units of 1 ( (Note: this unit is reserved for clinical operation), and the dial on the cutting machine is 5 . When the epidermis sheet is 8-10, the thin medium thickness sheet is 12-20, and the thick medium thickness sheet is 22-30. When slicing, apply glue to the drumhead and leather surface to stick to the skin. The range depends on the size of the desired skin. The operator holds the handle in the left hand and holds the knife holder in the right hand. The front edge of the drum is first brought into contact with the donor area, and then gently pressed and then turned up. At this time, the skin is stuck into a wrinkle shape, the knife is cut into the cortex, and the drum surface is continuously Flip up and pull the knife holder to cut to the desired size. Second, flap transplantation The pedicle-transplanted skin is called a flap. The surgical procedure consists of three steps: forming, transferring, and breaking the pedicle. It takes a long time and is more complicated than the skin graft. The flaps are mainly divided into flat flaps and skin tubes. 1. Flat flaps are often used for the repair of nasal defects. Most of the adjacent forehead flaps are applied, and the thickness and color after repair are similar to those of the defect area, and the effect is better. 2. The skin tube is in the predetermined feeding site, and the two parallel incisions with the long axis and the main blood vessel are aligned, and one side of the incision is peeled off to the opposite side of the fascia surface until the contralateral incision forms a skin strip. Strictly stop bleeding and sew into a leather tube (Figure 4). The wound edge of the donor site is widely dissociated, and the wound tension is reduced and sutured. The ratio of the length to the width of the skin tube should not exceed 2.5 to 3:1, otherwise it is not easy to survive. After the formation of the skin tube, pay attention to the blood supply, do not twist the pedicle, so as not to cause necrosis. After the skin tube is formed for 3 to 4 weeks, it is transferred, and after 3 to 4 weeks, the pedicle is cut. Before the pedicle, use a thin rubber band to clamp the pedicle for clamping training, temporarily blocking the blood supply and preventing the sudden loss of blood supply from affecting survival.

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