Abdominal bag flap transplantation

Abdominal flaps are often used to repair large wounds on the hands. They have the advantages of larger flaps, concealed skin areas, more comfortable postures, and easier limb braking. 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, the scar after healing is not easy to be exposed in the future, and 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: keloids Indication After the right hand injury, the volar side of the volar contracture contracted, and the tendon and bone defect were combined. In order to improve the appearance and repair of tendon and bone defects in the future, scar removal and abdominal flap transplantation 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. Design the flap at the appropriate position on the abdomen according to the area and location of the skin defect of the injured limb. 2, cut the skin along the flap design, free in the shallow layer of deep fascia, and according to the thickness of the affected area, trim the subcutaneous fat, carefully stop bleeding, but the subcutaneous fat of the pedicle should not be excessively trimmed, so as not to affect the blood of the flap supply. 3, the skin defect caused by the abdominal donor area, often can be directly tied and stitched. When the area of the skin defect in the donor area is too large, the wound is first reduced, and the remaining part is covered with a leather sheet. 4. Cover the forearm or hand skin defect area with the flap. 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 graft 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 any abnormal report