游离皮瓣移植修复头颈部恶性肿瘤根治切除术组织缺损围手术期护理

Perioperative nursing care of free flap transplantation for repairing tissue defects after radical resection of head and neck malignant tumors

目的 总结游离皮瓣移植修复头颈部恶性肿瘤根治切除术致大面积组织缺损患者围手术期护理措施。方法 收集和整理2020年1月至2023年1月在我院接受游离皮瓣移植修复头颈部恶性肿瘤根治切除术致大面积组织缺损的25例患者临床资料和护理措施,总结出包括术前心理护理,呼吸道、消化道及术区皮肤准备,术后疼痛护理、血管危象和皮瓣坏死预防护理、饮食护理,出院指导护理等围手术期护理,并观察其护理效果。结果 25例患者均顺利完成手术,术后移植皮瓣均存活,其中1例出现皮瓣感染、1例出现皮下血肿、1例出现血管危象,经早期干预护理和对症治疗后皮瓣存活。术后6个月复查无复发病例,2例出现明显瘢痕形成,1例色素沉着,24例患者表示对术区外观满意;1例患者术后存在语言功能障碍,1例存在吞咽功能障碍,其余23例患者均表示对疗效满意。结论 科学有效的围手术期护理是保证头颈部恶性肿瘤根治切除术致大面积组织缺损游离皮瓣移植修复患者皮瓣存活的关键,对促进康复,降低并发症发生率,提升临床疗效和美容效果具有重要作用。

Objective Summarize the perioperative nursing measures for patients with large tissue defects caused by radical resection of head and neck malignant tumors treated with free flflap transplantation.Methods Collect and organize clinical data and nursing measures of 25 patients who underwent free skin flflap transplantation to repair large tissue defects caused by radical resection of head and neck malignant tumors in our hospital from January 2020 to January 2023.Summarize perioperative care,including preoperative psychological care,respiratory,digestive and surgical skin preparation,postoperative pain care,vascular crisis and flflap necrosis prevention care,dietary care,discharge guidance care,and other perioperative care,And observe its nursing effffect.Results All 25 patients successfully completed the surgery,and the transplanted flflaps survived after the surgery.Among them,1 case developed skin flap infection,1 case developed subcutaneous hematoma,and 1 case developed vascular crisis.After early intervention and targeted treatment,the flflaps survived.After 6 months of surgery,there were no recurrent cases,2 cases showed obvious scar formation,1 case had pigmentation,and 24 patients expressed satisfaction with the appearance of the surgical area;One patient had postoperative language dysfunction,one patient had swallowing dysfunction,and the remaining 23 patients expressed satisfaction with the therapeutic effffect.Conclusion Scientifific and effffective perioperative care is the key to ensuring the survival of patients with large tissue defects caused by radical resection of head and neck malignant tumors through free flflap transplantation.It plays an important role in promoting rehabilitation,reducing the incidence of complications,and improving clinical effifficacy and cosmetic effffects.