Forearm retrograde island 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. When the flap is healed at the skin graft for about 3 weeks, a new blood circulation system is gradually established, and the pedicle can be cut off, and the flap transplantation process is over. Sometimes, some flaps can be continually pedicled, such as a partial rotating flap or a propping flap. After the flap is transferred, due to the full-thickness skin and rich adipose tissue, the contractility is much smaller than that of the free skin graft, and it can withstand external friction and maintain the original color before the flap is transferred. In the cosmetic surgery, the flap can cover deep wounds, protect deep tissues, and is an ideal material for organ and body shape cosmetic surgery. Such as nasal reconstruction, correction of lip deformity, correction of eyelid valgus, ear reconstruction, breast reconstruction, penile reconstruction, etc. are particularly suitable. In the head and face plastic surgery, flap transplantation, especially local rotating flap transfer is also indispensable for the repair of scar after resection, scalp defect repair and shaping. Because the supply area of facial flaps is small, it is not suitable for large-area cosmetic plastic surgery. For large facial defects (such as large-area hemangiomas, large area of black sputum resection or large-area scar resection), cosmetic plastic surgeon They can also use the distal flap for plastic surgery, often with thoracic triangle flaps and neck flaps. This kind of flap has several advantages for facial cosmetic surgery: one is that the repair area is large; the other is that the flap area is concealed, and the scar after healing is not easy to be exposed in the future; the third is that the skin area of the flap is close to the color of the facial skin, and the face is After shaping, the skin color is close to or not much different. However, the plastic surgery of the distal flap is complicated and time consuming, and the postoperative appearance is somewhat bloated, and sometimes a second fat removal surgery is required. Treating diseases: traumatic ulcers 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 The back of the right hand was crushed by the car. The back of the hand is avulsed, the metacarpal fracture, and the interosseous muscle contusion. After debridement, the metacarpal fracture was fixed with Kirschner wire, and the wound was repaired by the reversed island flap of the forearm. Flap design: Point: the pulsation point of the brachial artery on the wrist. Line: The brachial artery beat point is 2.5 cm below the center of the elbow fossa. Face: The flap is designed on the proximal side of the vessel axis according to the area and shape of the skin defect and the length of the desired vessel. The flap was designed to be peeled off from the deep fascia and the sarcolemma, and the radial artery, the two accompanying veins and the cephalic vein were included in the flap. Lift the flap and keep the radial artery and vein as the vascular pedicle. The proximal end of the radial artery was clamped with a blood vessel clamp, and the blood supply of the hand, the radial artery beat, and the bleeding of the skin flap were observed. If there was no abnormality, the proximal end of the flap was cut and the agitation and vein were ligated. The flap is worn from the subcutaneous tunnel to the back of the hand to cover the wound. Note that the tunnel should not be narrow, and the vascular pedicle should not be folded and jammed. Observe the blood supply to the flap again. Suture the flap. The forearm donor area is repaired with a thick fault skin. The dressing pressure should be appropriate and should not interfere with the blood supply to the vascular pedicle of the flap. The wrist is braked with a plaster for two weeks to reduce activity and avoid affecting the blood circulation of the flap. complication 1. Postoperative care of hand flap transplantation is based on postoperative care routine. 2, the whole body situation observation: 1 blood volume observation, insufficient blood volume can cause peripheral blood vessels to contract, affecting the blood supply of the transplanted flap, threatening the survival of replanted tissue, thus closely observing the patient's pulse and blood pressure changes; 2 Observe the amount of liquid in and out, pay attention to maintain 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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