指动脉背侧支皮瓣修复术后血管危象的早期诊断和护理治疗

Early diagnosis and nursing care of vessel crisis after finger defect reconstruction of the flap pedicled on the dorsal branch of proper digital artery

目的：探讨指动脉背侧支皮瓣修复术后皮瓣血管危象的早期诊断方法及护理措施。方法：应用针刺法和常规观察法相结合,密切观察26例患者的32指指动脉背侧支皮瓣修复术后皮瓣的血运情况,记录皮瓣血运发生变化的时间、术后疼痛程度等,并及时予以护理干预和治疗。结果：术后30指疼痛介于轻、中度之间,2指疼痛重度,经对症治疗后缓解。皮瓣血运变化可早在术后24-48 h内被发现。其中,28指皮瓣术后完全成活,另4指皮瓣在术后24 h内被及早发现血管危象,经三抗治疗、皮瓣按摩、放血及换药处理后完全成活。术后随访6-10个月,皮瓣质地优良,患侧手指外形满意,屈伸活动良好,供区无明显色素沉着。患指皮瓣的静止和运动两点辨别觉分别平均达9.2和9.0 mm。结论：严密细致的护理观察、可靠的早期诊断技能及周到完备的基础护理是指动脉背侧支皮瓣修复术后最终成活和早期康复的重要保障。

Objective： To investigate early diagnosis and nursing care of vessel crisis aft er finger defect reconstruction of the flap pedicled on the dorsal branch of proper digital artery. Methods： With needling and observing methods, we found out the blood supply of 32 flaps pedicled on the dorsal branch of proper digital artery, and kept a record of the changed period of blood supply and postoperative pain. And the nursing care was well done immediately.Results： Th irty injured fingers were suffered from mild to moderate pain postoperatively, with two fingers severe pain. All the pains were alleviated aft er appropriate treatment. The blood supply of flaps could be found out 24-48 h postoperatively in time. Twenty-eight flaps in our series survived uneventfully during the follow-up period（range,6-10 months）. The other four flaps were rescued timely with nursing care. All the patients were contented with the aesthetic and functional outcome of the flaps. Range of movement of injured fingers was nearly normal. The average static and moving two-point discrimination of the flaps was 9.2 and 9.0 mm. Conclusion： Careful nursing observation, reliable early diagnostic skills and thoughtful basic nursing is the most important guarantee of the ultimate survival and early rehabilitation after the reconstruction of the flap pedicled on the dorsal branch of proper digital artery.