Abdominal Tubular Flap Transplantation

The tubular flap is a tubular flap that is rolled inwardly into a tubular shape. The length and width ratio are generally 3:1; because it is completely free of wounds, it is also called a closed flap. This flap can be transferred to a remote location, expanding the range of flap applications. The disadvantage is that the number of operations is high and it takes a long time. After the introduction of free flaps, the use of skin tubes has been greatly reduced. In the determination of the defect site can not be repaired with a flat flap, and should not be used when free flap transplantation, can be repaired with a skin tube. Redesign the length, width, location and transfer method of the tube. According to the location of the skin tube, it is divided into abdominal skin tube, chest and abdomen tube, shoulder and chest tube, upper arm tube and neck tube. Treating diseases: vascular injury Indication Generally, deeper deformities cannot be repaired by skin flaps, or those with deep muscle tendons, nerves, bones, and large blood vessels need to be repaired with flaps. 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. 3. Fresh wounds should be treated according to the debridement steps, so that the wounds have no active bleeding and necrotic tissue, and the edges are trimmed neatly. 4. The donor site should be shaved 1 day before surgery, brushed with soapy water, wiped dry, then rubbed with alcohol, wrapped with sterile towel, can not use strong disinfectant (such as iodine, etc.), so as not to damage the epidermis, reduce The skin is vital. Skin disinfection was performed with 1:1000 thiomersal and 75% alcohol during surgery. Surgical procedure After the right hand injury, the ring and the little finger are missing, and the back of the hand, the palm of the hand, and the thumb are curled up. The palms and the back of the hand are connected together, and the skin has a ring-shaped defect. It should not be repaired with a flat flap. A pair of pedicled tubular flaps are formed obliquely in the left abdominal wall, which is 20 cm long and 8 cm wide. After 4 weeks, a delay was performed at one end of the proximal abdomen line. Piper tube transfer was performed within 2 weeks of delay. Remove the scar from the hand and loosen the thumb. A triangular flap or scar flap is placed on the volar side to seal the triangular skin defect of the base of the sheath after the transfer of the tube. After the thumb is opened, the first and second metacarpals are fixed with two Kirschner wires to maintain the large position. Another two Kirschner wires were used to brake the metacarpophalangeal joint of the index finger to the functional position. Transfer one end of the tubular flap to the back of the hand and the thumb. The line was removed two weeks after surgery. At the beginning of the skin tube, the clamp training is started. After the clamp training is completed, the proximal end of the tubular flap can be cut and transferred to repair the wound after the palm scar is removed. The tubular flap has been transferred to the back of the hand and the palm of the hand, but the middle tube has not been flattened. After 4 weeks, the skin tube was cut and flattened, the scar tissue was carefully removed, the flap was smoothed, and the palm side muscle was released. The flap was sutured to complete the transfer of the tubular flap. Remove the Kirschner wire for functional exercise. The flap is transferred and the thumb is opened to the side of the back of the hand. After the scar is removed, the tendon, nerves and bones are exposed inside the wound. According to the size and shape of the wound, trim the sample cloth and leave the hypothetical flap pedicle on the ulnar side of the hand. Move the hand and sample cloth to the appropriate position on the abdomen. Hold the sample cloth, remove the hand, and then attach the sample cloth to the abdominal wall. Draw the contour on the abdominal wall according to the shape of the sample cloth and the position of the pedicle, which is the flap to be cut. Cut the skin according to the contour of the flap, peel off the shallow fascia, and lift the flap. In order to make the flap flat, it is necessary to trim the thick fat under the flap and stop the bleeding carefully. The donor site of the abdominal wall donor area is covered with a medium-thickness skin. The edge is stitched with a long line for pressure bandaging. Move your hand to your abdomen. The free edge of the skin piece located on the pedicle of the flap is continuously sutured to the side edge of the hand wound ulnar to seal the wound surface of the pedicle of the flap. In order to make no gap in the fold of the pedicle of the flap, the free edge of the flap is sutured with the subcutaneous tissue of the flap (note that the flap is not injured). Stitch the flap with the hand wound. The donor skin is made into a pressure bandage. Place a cotton pad between the affected limb and the chest and abdomen wall, apply the dressing on the affected hand and the donor area, firmly brake the affected limb with the chest and abdomen with a wide adhesive, and then fix it with a belly band. 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 blood, pay attention to the graft flap with or without vasospasm, if there is abnormal report to the doctor in time, with the same finger replantation. 4, the limbs are properly raised, can reduce limb swelling, while paying attention to the flap area to avoid compression