Free inguinal flap transplantation

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: intestinal fistula tendon 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) Reconstruction of organs such as the nose, lips, eyelids, eyebrows, ears, penis, and fingers are all based on flaps, and then combined with other supporting tissues (such as cartilage, bone, fascia, etc.). (3) The repair of a hole-filled defect, such as a cheek-portable defect, often requires a flap with abundant blood supply in addition to the lining. 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 to improve nutritional status such as radiation ulcers, hemorrhoids, etc., local nutrition is poor, wounds are difficult to heal, blood is transported through the flap, and local nutritional status is improved. Therefore, the flap is preferably a local axial flap. Or island-shaped flaps, and do not need to do the pedicle surgery, so that not only can maintain a good blood supply in the repair area, and can be expected to have a better 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. Surgical procedure 1. Flap design: Point: 2cm femoral artery pulsation below the inguinal ligament. Line: The connection between the beat point and the anterior superior iliac spine. Face: 4cm of the line is the width of the flap, and the length of the line is the length of the flap. 2. Cut the skin at the edge of the flap, deep exfoliation from the deep fascia, pick up the flap, superficial circumflex artery and vein included in the flap. The superficial temporal artery and vein branch were found in the femoral artery and the saphenous vein. The ligament was ligated and cut off as the vascular pedicle of the flap. The wound is directly sutured in the flap area. After debridement of the back of the hand, the deep branch of the radial artery and the cephalic vein were exposed in the wrist, which were respectively anastomosed with the circumflex and vein of the flap. 4. After the flap is reconstructed from the blood circulation, the flap is sutured. The rest of the hand can receive free skin grafts and repair with thick fault skin. 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, pay attention to the graft flap with or without vasospasm.