体表肿瘤切除及皮瓣修复术后护理体会

Experience in Postoperative Nursing of Body Surface Tumor Resection and Skin Flap Repair

目的探讨体表肿瘤切除+皮瓣修复术后护理的重要性。方法 2015年3月—2016年6月中国医学科学院皮肤病医院皮肤外科收治的643例体表肿瘤患者于肿瘤切除+皮瓣修复术后予以创面换药、饮食指导等常规护理,以及术后出血、切口开裂、创面感染、皮瓣坏死、瘢痕增生等常见并发症的护理,观察护理效果。结果所有患者均顺利完成体表肿瘤切除及术后创面皮瓣修复治疗,其中出现创面感染者45例,均经生理盐水清洗、碘伏消毒等处理后痊愈,且愈后皮肤均无明显瘢痕增生;出现皮瓣坏死者3例,均经0.1%雷夫诺尔纱布湿敷及敏感抗生素抗感染治疗后痊愈;出现瘢痕增生者77例,均经瘢痕内注射曲安奈德联合硅凝胶或疤痕软膏局部按摩后好转;部分患者术后出现焦虑、抑郁等情绪,均经专业心理护理后好转;其余患者皮瓣成活较好,愈后皮肤无明显瘢痕增生,患者较满意。结论在加强术后健康宣教及创面常规护理的同时,针对术后创面出血、感染、瘢痕增生等并发症给予加压包扎、局部按摩、穿戴压力衣等防治性对症护理,可有效提高皮瓣成活率及创面愈合质量,降低瘢痕增生率,疗效显著,值得临床推广应用。

Objective To investigate the importance of nursing after body surface tumor resection and skin flap repair. Methods 643 patients admitted to Dermatologic Surgery,Institute of Dermatology and Hospital for Skin Diseases,Chinese Academy of Medical Sciences(CAMS） after body surface tumor resection and skin flap repair were given routine nursing such as dressing change and dietary instruction and nursing for common complications including postoperative bleeding,rupture of incision,wound infection,skin flap necrosis and scar hyperplasia. The nursing effect was observed. Results Body surface tumor resection and postoperative skin flap repair were successful on all patients. 45 patients got wound infections which were healed with management including sterilization with normal saline solution and iodophor,and no obvious scar hyperplasia was observed on their skin. 3 patients got skin flap necrosis which were then recovered after treatment with 0. 1%Ethacridine Lactate gauze and sensitive antibiotics. 77 patients got scar hyperplasia and their conditions were improved after injection of triamcinolone combined with local application of silicone gel or MEBO Scar Ointment. Some patients experienced anxiety and depression after surgery,but all of them improved after professional psychological care. The rest patients were satisfied with their treatment： they got high survival rate of skin flap and no obvious scar hyperplasia was observed on their skin. Conclusion While enhancing postoperative health education and performing routine nursing,preventative symptomatic nursing,like pressure dressing,local massage,and wearing elastic body suit should be performed to manage complications including postoperative bleeding,infection and scar hyperplasia. Such treatment can significantly improve survival rate of skin flap and wound healing quality and reduce scar hyperplasia,so it is deserved to be promoted in clinical practice.