Management of vascular anastomosis

In wartime, the main arterial injury of the extremities accounts for about 1% to 3% of all the injured, and it usually occurs. After arterial injury, it can immediately cause major bleeding and life-threatening, especially large arteries, such as the femoral artery, radial artery, and radial artery. Even if the bleeding stops, necrosis or dysfunction may occur due to insufficient blood supply to the distal limb. During the first and second world wars, the vascular injuries of the extremities were mostly treated by ligation, and the amputation rate was as high as 49%. In the past 40 years, the repair method has been used for the vascular injuries of the extremities, so that the amputation rate is reduced to 0 to 13.5%. At the same time as major vascular injuries in the extremities, nearby tissues such as bones, joints, muscles and nerves are often injured at the same time. However, important vascular injuries should be treated first. There are vascular injuries in the extremities, and there are arteries and veins. Most firearm injuries are both injuries. Arterial injury is often the main contradiction and should be repaired, but in the case of extensive soft tissue injury, the vein must also be repaired. Treatment of diseases: vascular injury, hand vascular injury, limb vascular injury Indication Suitable for sharp cuts or other patients who cause vascular damage requiring vascular chopping and suture stitching. Preoperative preparation 1. The blood supply to the blood vessel must be normal. The outer diameter should be similar to that of the receiving blood vessel. It should not be too different and should be of sufficient length. 2. After the supply of the vascular resection, it should cause blood circulation disorder (ischemia or blood stasis) in the donor area. 3. In general, arterial defects were reconstructed with arterial grafts and venous defects were reconstructed with vein grafts. However, clinical practice accounts for a small number of arteries, and a small number of arteries, and some arteries will cause insufficient blood supply in some areas. On the contrary, the location of the vein is superficial, the number is large, and it is easy to find. The superficial vein is removed for a period of time, and it does not cause reflux disorder. Therefore, in microsurgery, autologous vein grafts are often used to repair venous and arterial defects. 4. The autologous veins for transplantation include saphenous vein, small saphenous vein, external jugular vein, cephalic vein, expensive vein, dorsal vein and dorsal vein. The main saphenous vein, small saphenous vein and external jugular vein are too large, which is not suitable for the repair of small vessel defects. Generally, these vein branches are used. These vein branches have appropriate outer diameters and thin walls. They are the same as the superficial veins of the upper limbs, the back of the feet, and the dorsal veins of the hands. They are commonly used for autologous vein grafts. Surgical procedure 1. There is a layer of loose tissue around the outer membrane of the blood vessel. 2, the removal of extravascular loose tissue, so as not to be brought into the lumen by the needle, resulting in thrombosis, occlusion of blood vessels. The adventitia can not be damaged, otherwise it will cause scar contracture on the wall. 3. Use a microscopic vasospasm to gently dilate the iliac vessels and flush the lumen with heparin saline for anastomosis. complication Anastomotic ulcer, nocturnal pain, often radiated to it, abdominal pain episodes are longer, and the remission period is shorter. Eating or antacids can be temporarily relieved. Anorexia, nausea, vomiting, and weight loss are common, and some patients may have perforation, obstruction, and bleeding.

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