Scalpel Skin Removal and Skin Grafting

Skin grafting is the removal of a portion of the skin at the site of the healthy skin (the donor area) to cover the area where the scar has been removed (the recipient area). The skin of the donor area needs to be supplied with new blood vessels in the receiving area to survive. Under normal circumstances, the chances of successful autologous skin transplantation are great, but there is also the possibility that the skin graft will not survive. In addition, all skin grafts will leave scars in the donor area. Treating diseases: scar burns Indication It is suitable for patients with thick wounds or full-thickness skins when the wound surface is small and the required skin area is not large. Contraindications Patients with systemic disease intolerance, the wound has a large number of tendons, bone tissue, nerves, blood vessels and other exposed. 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. 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. When the wound surface is small, the required skin area is not large, and a thick or full-thickness skin can be cut with a scalpel. The deep side of the skin is slightly trimmed and ready for transplant application. The donor site can be directly sutured for aesthetic purposes, and the donor site is often selected in areas where the skin is loose and concealed, such as the groin, the medial upper arm, the lower clavicle or the volar side of the wrist. 2. Oval skin defect on the back of the finger. The substrate can accept free skin grafts. 3. Use a scalpel to take the skin on the proximal side of the lateral wrist. An oval skin piece is actually needed, but in order to facilitate the suturing of the skin wound, a fusiform piece can be cut. Cut the edge of the skin and the desired thickness, then peel off from one end and remove the skin. 4. After the skin piece is removed, the scissors are deepened to make it flat and cut off the excess skin. The donor site can be sutured directly. If the skin is taken as a thick fault, the part of the dermis remaining on the wound surface is removed and the wound is sutured. 5. The skin graft covers the wound surface, and the edges are sutured and long lines are left for dressing. 6. Cover the skin with oil yarn, then stack the mesh gauze, evenly press the skin, and then fix it with the long line left, so that the skin and the compression zone are in close contact, so as to facilitate the healing of the skin. 7, the right thumb of the big fish electric saw injury, the thumb has been crushed. After debridement, the metacarpal stump is covered with soft tissue so that the wound can receive free skin grafting. 8. Take thick tomographic skin on the inside of the ipsilateral forearm to repair the wound. 9. Cut a thick section of the skin with a scalpel. 10. Excision of part of the dermal tissue on the donor site and suturing the wound directly. Use the skin to repair the wound in the affected area, and suspend the long line on the peripheral edge. The oiled gauze and the mesh gauze on the skin graft are evenly pressure-wrapped. complication 1, shock: early in the majority of hypovolemic shock. In the case of concurrent infection, septic shock can occur. Extraordinary burns are stimulated by intense damage and can be immediately shocked. 2. Sepsis: Burns cause defects in the skin's barrier to bacteria; heavier patients also have weakened white blood cell function and immune function. Therefore, infection is easy to occur. The pathogenic bacteria are bacteria (such as Staphylococcus aureus, etc.) or exogenously contaminated bacteria (such as Pseudomonas aeruginosa). Suppurative infections can occur on the wound surface and under the eschar. The infection may also develop into sepsis and septic shock. In addition, after the use of broad-spectrum antibiotics, especially in patients with systemic weakness, fungal infections can be secondary. 3, lung infection and acute respiratory failure: lung infection may have a variety of reasons, such as respiratory mucosal burns, pulmonary edema, atelectasis, sepsis and so on. Adult respiratory distress syndrome or pulmonary infarction may also occur, leading to acute respiratory failure. 4, acute renal failure: renal ischemia before and after shock, severe renal capsule and renal tubules deteriorate, with hemoglobin, myoglobin, infectious toxins can damage the kidney, it can lead to acute renal failure. 5, stress ulcers and gastric dilatation: duodenal mucosal erosion, ulcers, bleeding, etc. after burns, known as Curling ulcer, may be related to the gastrointestinal tract once ischemia, reperfusion, hydrogen ion countercurrent damage to the mucosa. Gastric dilatation is often caused by a large amount of water in the diseased population when the early gastric peristalsis is weakened. 6, other: myocardial function is reduced, the stroke volume can be reduced, and related to the production of myocardial inhibitory factor, infection toxin or myocardial hypoxia after burn. Brain edema or hepatic necrosis is also associated with hypoxia, infection, and the like. It is worth noting that the death of burns is often caused by multiple system organ failure.