Abdominal 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. 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, 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 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 smooth the flap, it is necessary to trim the thick fat under the flap. Stop 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 properly raised, can reduce limb swelling, while paying attention to the flap area to avoid compression.