(2) Skin color mainly depends on whether the skin color of the transplanted tissue is ruddy, pale and purple. Because the skin color of different parts of the human body is different, it should be compared with the skin color around the donor area and the recipient area. If the skin becomes shallow or white, it indicates insufficient blood supply to the artery, embolism or spasm. On the contrary, when the color is larger or the whole piece becomes dark, the obstruction of venous blood return should be considered. With the aggravation of thrombus, it becomes reddish purple or black purple. In this group, 4 cases of skin flap edge necrosis were affected by local baking lamp irradiation at that time, which did not attract the attention of nurses and eventually led to skin flap edge necrosis.
(3) The skin temperature should be compared with the adjacent normal tissues. Generally, the skin temperature difference between the transplanted flap and the healthy side is 0.5℃-2℃. If the temperature difference is lower than 2℃ than the normal skin temperature, it means that blood circulation disorder will occur. If the skin temperature suddenly rises beyond the normal range, and the tingling or pain continues to increase, it indicates the possibility of infection. The transplanted skin flap is often covered with multiple layers of gauze to prevent it from being affected by external temperature. Four days after operation, the skin temperature of 2 cases in this group began to increase, and the pain increased, and finally the healing was delayed due to infection under the flap.
(4) All flaps had edema after operation. After 3-4 days, the veins gradually communicate, which can quickly improve the venous return of the flap and reduce the swelling. According to the degree of swelling, dermatoglyphics may exist, disappear and blister. The flap with insufficient arterial blood supply collapsed and dermatoglyphics increased; Venous reflux is blocked, dermatoglyphics disappear, tension increases, the surface is bright, there are blisters or dermatoglyphics bleeding, such as arterial and venous embolism at the same time, the degree of swelling remains unchanged.
(5) Capillary reaction: Press the skin of the flap with a cotton swab to make the skin color white, and then remove the cotton swab to make the skin color red. This time is the capillary filling time, which is normally 1-2s. If the capillary fills slowly or disappears, it may be the interruption of blood circulation, which should be paid attention to immediately. The author thinks that the observation of capillary filling time should be considered comprehensively with other indexes.
(6) To judge the growth of the skin flap, insert the nail head into the skin flap for 5mm, and then gently squeeze the surrounding tissue after pulling it out. If bright red blood overflows, it means normal. If there is still no blood overflow after repeated acupuncture, it indicates that there may be an arterial crisis; If there is dark red blood overflow, it means that the venous blood flow is blocked. If you find the above situation, you should inform the doctor in time to avoid myocutaneous flap necrosis. Early detection and early treatment is the key.
(7) Heat preservation after heat preservation nursing is particularly important. The local skin flap was continuously irradiated with 60W baking lamp for 7- 10 days, and the baking distance was 30-40cm. Cover the lampshade and skin flap with sterile towel to keep warm, but pay attention to keep the baking lamp from being too close to the skin flap to avoid burns, and irradiate intermittently in summer.
(8) Postoperative posture is one of the important measures to ensure the blood supply and venous return of the flap and promote the survival of the flap. After operation, keep the affected limb higher than the heart, raise the affected limb 10- 15, and maintain the functional position or make appropriate adjustments according to the surgical site. To ensure arterial blood supply and promote venous return.
It is forbidden to lie flat on the affected side to prevent the flap from being compressed or pulled, and to avoid the ischemic necrosis of the flap caused by the spasm of the flap. Try to conform to the patient's body position, visit patients frequently, especially those who are sleeping, pay attention to maintaining their body position, and explain the importance of fixed body position to patients, so that they can closely cooperate with treatment and correct incorrect body position in time.
(9) Pain Care Pain can make the body release 5- hydroxytryptamine (5-HT), which has a strong vasoconstrictive effect. If not treated in time, it may cause vasospasm or thrombosis, and the drug should be given in time after operation. Local dressing should be fixed to protect limbs, so as not to damage the flap and cause pain during activities, and the dressing should not be too tight to prevent oppression. All postoperative treatment and nursing actions are gentle, such as injection, infusion, dressing change, drainage tube removal and so on. , to minimize the pain.
(10) The blood volume is insufficient to maintain effective blood circulation, which may lead to a decrease in cardiac output and contraction of peripheral blood vessels, thus affecting the blood supply of the flap and threatening the survival of replanted tissue. Therefore, we should pay attention to the observation of vital signs and general conditions after operation to supplement blood volume. At the same time, anti-spasm and anti-thrombosis were given according to the doctor's advice, and the curative effect and side effects of the drugs were observed.
(1 1) In order to prevent early wound infection, timely and reasonably use antibiotics, strictly operate aseptic technique, keep the dressing clean and dry, keep the flap drainage unobstructed, observe the color, quantity and nature of drainage fluid, and make records to prevent blood accumulation in the skin gap of the flap and affect the survival of the flap. Give dietary guidance, guide to eat a high-protein, high-calorie, high-vitamin diet, enhance resistance and promote tissue repair. At the same time, strengthen basic nursing, prevent pressure ulcers, disinfect the air in the ward every day, and open the window regularly for ventilation.