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Skin expansion has been applied in China for nearly 20 years and has become one of the most commonly used treatments in plastic surgery. Since this technique was developed in our department from 65438 to 0985, thousands of patients have received skin expansion treatment and achieved satisfactory results. It takes about 1~2 months to transfer the flap from the first-stage dilator to the second-stage dilator. During the infusion of dilator, patients often have local symptoms or general discomfort. This paper summarizes the experience of handling more than 2 000 cases of common problems in the process of dilator infusion from 1998 to 2005, and introduces them as follows.

1 local pain

Pain is the most common symptom in the process of dilator injection, especially when the scalp, forehead and limbs of adults expand. Generally, severe pain occurs within 24 hours after injection, sometimes the pain is unbearable, and individual patients demand to stop expanding injection because of unbearable. The main causes of pain are the skin tightness of scalp, forehead and limbs of adults, the compression of nerves by dilators and the sensitivity of individuals to pain. Prevention and treatment: Preventive application of analgesic drugs, such as oral analgesic and analgesic suppository, 30min minutes before injection. In the process of injection, nurses should give patients a high degree of sympathy and understanding, take the initiative to care for patients, take a small amount of slow injection or add lidocaine and other local anesthetics to the injection to relieve pain. Some patients can effectively relieve pain by using local nerve block before injection.

2 Push injection is difficult

It is often difficult to push injection during injection, and the possible reasons are as follows: ① the injection position is not accurate; ② The injection needle is not completely inserted into the injection pot; ③ The dilator catheter is twisted or folded. Prevention and treatment methods: when injecting liquid, first find out the position of the injection pot, and then push the injection when the needle of the syringe pricks the metal plate of the injection pot (feeling metal collision). If the dilator catheter is twisted and folded, please seek surgical assistance from your doctor and adjust the position of the dilator catheter.

I can't find the injection pot.

It is necessary to find the position of the injection pot before injection, but it is often difficult to touch the skin surface because the injection pot is displaced or turned over under the expansion sac or buried under the thick scar. Treatment: confirm the position of the valve according to the operation record of the patient's dilator implantation and the surgeon. If you are still not sure, use X-ray to find out the position of the valve, mark it and prepare for the next injection.

4 "sharp corner" formation of the expansion bag

When the dilator is placed, it is not completely flattened, which may form "folds" or "sharp corners", which may easily lead to local skin ulceration and should be dealt with actively and promptly. Prevention and treatment: when the dilator is implanted, the separation cavity is larger than the dilator 1.0cm[ 1], and the expansion sac should be flattened as much as possible; Inject as much liquid as possible during the operation to prevent the expansion sac from wrinkling, and more importantly, give appropriate pressure to the skin and soft tissue at the beginning to stimulate the skin as soon as possible and promote the division and proliferation of epithelial cells [2]; When injecting liquid after operation, inject as much liquid as possible to fill the folds or "sharp corners". The cotton ball can also be attached to the skin surface of the "sharp corner" of the expansion sac with adhesive tape to play a protective role.

5 dilator does not expand

Due to various reasons before, during and after operation, the expansion sac or dilator catheter is broken or the dilator catheter is folded, which may cause the dilator to be unable to expand. The injection pot cannot be expanded even if it is shifted and turned over. Prevention and treatment methods: ① Before placing the dilator, carefully check whether there is leakage or rupture of the dilator; During the operation, avoid sharp instruments touching the dilator. The injection pot is buried at a certain distance from the expansion sac, and the catheter of the dilator cannot be folded. After suturing the incision, inject liquid into the expansion sac again to check whether the catheter is unobstructed. ② In the process of injection, the operator must master the correct injection method to ensure that the injection is injected into the expansion sac; ③ If the expansion sac or catheter is ruptured, it should be surgically removed as soon as possible and the dilator should be replaced again.

6 dilator causes infection

The common reasons are: the aseptic operation is not strict in the process of embedding dilator or injecting liquid; There are infected lesions on the surface or around the dilator and near the incision; Dilator exposure, hematoma; Patients generally have low resistance; Infection can be caused by infections in other parts of the body. The skin on the surface of the dilator is red, swollen, hot and painful, and the skin on the surface of the dilator is ulcerated, with purulent secretions and elevated body temperature. Prevention: ① Focus on prevention: pay special attention to aseptic operation during operation and infusion; Anti-infection therapy after dilator implantation. ② Once signs of infection such as redness, swelling and fever are found, decisive measures should be taken as soon as possible. Inject gentamicin or sensitive antibiotics into the expanded capsule; Oral or intravenous injection of sensitive antibiotics; Applying dandelion juice on the skin surface of the red dilator; If the expanded skin has ulceration and pus, it must be fully drained, dressing change should be strengthened, and sensitive antibiotics should be applied all over the body.

7 Treat patients' general malaise symptoms.

In the process of liquid injection, some patients often have systemic symptoms such as nausea, vomiting, cold sweat, pallor, chest tightness and blood pressure drop. It may be related to the compression of carotid sinus by neck expander or the mental stress and physical condition of patients. In case of the above situation, stop injecting liquid immediately or extract some liquid to decompress, so that the patient can rest on his back, which can generally relieve himself, and severe cases can be treated symptomatically. Because it takes a long time for dilator to inject liquid, complications are easy to occur during injection. With the increase of injection volume, self-image is affected, and patients often have a heavy psychological burden. Individual patients lack patience and are unwilling to cooperate with treatment. Therefore, preoperative nurses should know the patients' thoughts and requirements in detail, give them sympathy, understanding and care, and explain in detail the possible complications and their own protective measures in the process of fluid replacement, so as to relieve their unnecessary worries and help patients build up confidence and successfully complete the fluid replacement process.

To sum up, correct measures should be taken in time to solve the common problems in the process of water injection of dilator, so as to ensure the smooth implementation of the second stage operation of dilator and satisfactory surgical results for both doctors and patients.