Drum skin extraction

With the improvement of the requirements for the repair of skin defects, the skin dermatosis is widely used in burns and orthopedics because of its intact skin and uniform thickness. Compared with the general roller knives, the leather drum is technically difficult and complicated, and has its own characteristics in terms of nursing cooperation. Treating diseases: burns Indication The drum type peeling machine takes a uniform thickness of the skin, and can cut the skin piece whose thickness and shape meet the requirements of the wound according to the needs of the wound surface. Drum-type peeling machine requires high skinning technology and requires a practical exercise process. Contraindications 1. Patients with severe heart, lung, liver, kidney disease and diabetes cannot undergo surgery. 2. People with potential infections in the body. 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 Wipe the drum surface with a clean gauze, place the blade to adjust the thickness of the skin, place it on the drum frame, and lock the drum surface upwards. Wipe the drum surface with ether and degrease. Apply dewatering on the drum surface in a certain order, the thickness is suitable, uniform, and should not be applied repeatedly. If the desired skin shape is special, apply dewatering on the drum surface in the desired shape. Degrease and dehydrate in the donor area with diethyl ether. Apply evenly to dehydration. After the glue is slightly dry, the operator holds the drum handle in the left hand and holds the handle in the right hand. The leading edge of the drum is aligned with the leading edge of the coating area of the donor area, and then the drum surface is brought into contact with the skin, and the pressure is pressed downwards. Push forward, while the drum is slightly rolled backwards, and the right hand holds the knife to make a saw-like action, and starts to take the skin. The operator's left hand pushes the drum down and rolls back, and the right hand takes the knife into a saw-like cut, and the two movements cooperate with each other to smoothly cut the skin. At the same time, pay attention to both sides of the drum during the peeling process. If the side cuts the skin wider than necessary, lift the side slightly; if the cut skin on one side is narrower than the required width, press the side drum slightly. To adjust the width of the skin. complication Infection, limb crushing.