anastomotic irrigation

The principle of treatment of major arterial injury is mainly to restore the continuity of the artery. The sooner the injured artery is repaired, the better. It is best to perform it within 6-8 hours after the injury. Delays in time will greatly increase the chance of distant intravascular thrombosis or infection, thereby reducing the likelihood of recovery from blood supply. However, if the distal blood vessels are not smooth, even if the time is longer, even more than 20 hours, the repair surgery is still possible. Treatment of diseases: hand trauma, mental trauma caused by traumatic brain injury, open hand injury Indication The penetrating injury caused by sharp sharps, the wounds are clean, the vascular clefts are small and neat, and it is estimated that the postoperative lumens will not be significantly narrowed before they can be repaired. If the wound is heavily contaminated, or if the blood vessels and surrounding tissues are squeezed, it is not advisable to perform a simple repair. Contraindications In addition to the matters that should be noted in the same blood vessel debridement, the following points should be noted: 1. If there are multiple injuries such as fractures and nerves, the fractures are usually fixed by internal fixation, and the blood vessels and nerves are repaired after restoring the stent. 2. The adventitia should be removed sufficiently to avoid embedding it in the anastomosis, resulting in thrombosis. For the diameter of the blood vessel within 2 mm, it is best to use the 9-0~11-0 Kaplan line of the non-invasive suture needle at both ends to reduce the needle. Each needle should be inserted into the vascular endocardium and the needle is placed in the outer membrane. In this way, it is easier to grasp the margin and the stitch length, and it is possible to avoid bringing the outer membrane into the lumen of the blood vessel. 3. When suturing, each time the needle is to be accurate, it is forbidden to repeatedly insert the needle and increase the damage of the blood vessel. Each needle must be clearly passed through the full layer of the vessel wall, bringing the intima on both sides together. Also maintain a certain stitch length and margins, do not be uneven, to make the tension average. 4. When sewing, use fine or no sputum, and the operation is gentle. When pulling the needle, it should be light and steady, and the needle should be pulled in the arc. If the wall of the blood vessel is brittle (especially the vein), the tip of the blood vessel must be pressed gently with a thin head to prevent the needle from being torn. At the same time, the surgical staff's gloves should be washed frequently, without blood, so as to prevent the suture from sticking to the gloves and tearing the blood vessels even by one action. 5. During the suturing process, the lumen and the wall of the tube should be continuously rinsed with heparin saline or the like to keep moist and flush out the clot. Preoperative preparation Temporary hemostasis Generally, the blood is temporarily stopped by pressure dressing, stuffing, etc., and the tourniquet is used as little as possible. There are fractured limbs that need to be temporarily fixed. 2. Prevention and treatment of shock Rapid blood transfusion, plasma or other expansion agents (such as dextran) to control shock. In case of emergency, first lose glucose or normal saline. 3. Improve blood supply If the blood pressure is relatively stable, it can be used as a sympathetic ganglion to improve the blood supply of the injured limb. For occlusive injury, sympathetic ganglion closure can identify vascular injury and vasospasm. After the sympathetic ganglia is closed, if the serious lack of blood supply to the injured limb fails to improve immediately, it needs to be surgically explored. 4. Anticoagulant Anticoagulants are generally not used before surgery. If surgery must be delayed for a few hours, heparin may be considered intravenously or subcutaneously in the absence of acute bleeding in the wounded to reduce the chance of distal thrombosis. Heparin has a short-acting effect and has little effect on subsequent surgery. If influential, it can be neutralized with protamine sulfate. If there is extensive damage to the soft tissue, it is best not to use anticoagulant to avoid large area exudation. 5. Injury preparation The skin of the entire injured limb should be disinfected in order to expose the distal vessel if necessary for retrograde thrombectomy. Surgical procedure During the vascular anastomosis, the hemorrhage was washed three times with heparin saline. Excessive rinsing will affect the operation, generally 3 times. The first flush is before the end of the fracture. The second flushing has been completed after the anterior wall of the blood vessel has been sewed, and after being turned 180 degrees, the lumen is flushed from the posterior wall. The third flush is before the last stitch of the stitching. complication Infections most often cause secondary bleeding and thrombosis. Therefore, in addition to thorough debridement, a sufficient amount of antibiotics should be given after surgery, usually for about 1 week.

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