digital vascular pedicle 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. Treatment of diseases: finger flexor tenosynovitis 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: If the patient has anemia, low plasma protein, dehydration, etc., it 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. Cut the skin according to the design, lift the flap from the deep part of the finger artery, cut off the proximal marginal artery of the flap, and use the distal end of the finger artery as the vascular pedicle of the flap. 2, resection of the stump scar, the flap reversed 180 degrees, repair the fingertip skin defect. The flap area is repaired with a medium-thick fault skin. complication Suppurative infection, infected wounds have pain, redness, tenderness, purulent secretions, etc., body temperature can be increased and neutrophils can be increased. Closed wounds may also be associated with various infections, such as post-injury aspiration, airway endocrine retention, and atelectasis secondary lung infections. Tetanus or gas gangrene may also occur after the injury, and the consequences are quite serious.