Tubular flap (skin tube) 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: burns 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, with systemic diseases, can not tolerate surgery. 2, local infection, not suitable for 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 1. Design and separation of the flaps according to the principle of the length and width of the skin tube is 3:1. Cut the skin, subcutaneous tissue and superficial fascia according to the scribing. After the fixed suture is pulled, the flap is gently separated between the deep and superficial fascia, so that the tissue above the superficial fascia is completely separated from the deep fascia, and two pedicle flap structures are formed. 2. Roll into a skin tube: cut off excess fat tissue. After no bleeding, the flap was rolled into a tube and sutured with a 3-0 to 5-0 nylon thread or a thin thread. The donor site can be sutured and sutured, and the 8 to 10 thick silk thread is used for the reduction and suture. The diamond-shaped wounds at both ends can be closed with a suture stitch; if the tension is too large, the medium-thickness skin can be transplanted and the wound is closed. 3. Wrap-fixing: the wounds in the donor area are sutured in a shape of >-<, respectively, placed on the skin tube and the donor area with Vaseline oil yarn, and the gauze pad is placed between the oil gauze, and two skin tubes are placed on both sides of the skin tube. The coarse gauze roll protects the tube from compression and then wraps. 4. Broken pedicle and metastatic skin tube: Whether it is a flat flap or a tubular flap transplanted to another site, it takes about 3 weeks to build a blood supply. Therefore, it takes 3 weeks to break the pedicle; if there is an infection, Then you need to extend the time. There are two common methods of transferring skin tubes: (1) One direct transfer: After the skin tube is formed for 3 weeks, the end of the skin tube is cut and transferred; after 3 weeks, the pedicle is broken, and it is cut along the suture, and after hemostasis, it is trimmed to a proper thickness, and part or all of the defect is repaired. [Image 6]. (2) Carrying and transferring of the wrist: Using the wrist to carry the leather tube, the leather tube can be transferred to a distant defect.