改良游离腹股沟皮瓣修复手及足部皮肤软组织缺损患者的护理

Nursing Care in Repair of Defect of Soft Tissue in Hand and Foot with Modified Free Groin Flap

目的:探讨改良游离腹股沟皮瓣移植修复手及足部软组织缺损患者围手术期的护理对策。方法:对12例手及足部软组织缺损患者行以旋髂深动脉为主干血管及以肌皮穿支为供血的游离腹股沟皮瓣移植术的患者完善术前准备,充分评估腹股沟区域皮肤情况,针对性做好术前指导,保护供受区皮肤血管,做好呼吸道准备:术后重点加强显微外科专科护理,掌握改良游离腹股沟皮瓣的观察要点,正确判断动静脉危象,做好供区护理,预防腹股沟疝发生,同时根据手术特点给予体位安置,引流护理,加强基础护理,落实健康教育,防止再次损伤。结果:11例皮瓣全部成活,1例皮瓣部分坏死,经换药后行植皮术创面愈合。腹部伤口均一期愈合。无护理并发症发生。术后随访(3～12)月,皮瓣外形满意,质地柔软。结论:科学的围手术期护理对提高皮瓣成活有着至关重要的作用。

Objective：To investigate the strategy of nursing care in repair of defect of soft tissue in hand and foot with modified free groin flap. Methods：In 12 patients suffered from defect of soft tissue in hand and foot repaired applying modified free groin flap which blood supply were deep iliac eircunflex artery and it＇s myocutaneous perfovating branch, preoperative preparation were done well, cutaneous condition in groin area were assessed completely, preoperative instruction were aimed directly, skin and vessel in recipient site were protected, respiratory passage were prepaied well; In postoperative stage, special nursing of microsurgery were strengthened in emphasis, main points to observe modified free groin flap were mastered, Ate articulo were adjusted correctly, nursing care in donor site were completed well, inguinal hernia were prevented, body position were resettled and nursing care in deainage were done according to the operative characteristics, basic nursing were strengthened, and health instruction were fulfiled to prevent injury again. Results：All flaps survived, partial necrosis in a flap happened, and wound healing was gained by change dressings and skin grafting. Primary healing was gained in wound of abdomen, and no nursing compliation happened. With following-up for （3-12） months, the appearance of flap were satisfactory, and the texture of flap were soft. Conclusion：Scientific nursing care in peri-operation made an important role in raising survival rate of flap.