1． Postoperative anesthesia recovery care
(1) Prepare oxygen, negative pressure suction device and ECG monitor.
(2) After the patient returns to the ward, he should lie in a supine position for 4 to 6 hours with his head tilted to one side to prevent suffocation and aspiration pneumonia after vomiting.
(3) Closely observe vital signs and keep records at all times.
(4) Implement postoperative medical instructions in a timely manner.
2. For recumbent care, patients should rest in bed for 4 to 6 hours, so that the tissue transplant site is slightly above the level of the heart. If the surgical site is on the face, they should be in a semi-recumbent position; the affected limb should be elevated and immobilized.
3． Diet care provides high-calorie, high-vitamin, high-nutrition, easy-to-digest, non-irritating diet, with moderate restrictions on fried foods.
4. Drainage care uses syringe negative pressure suction.
(1) Observe the nature and amount of wound drainage, and record the amount of drainage in 24 hours.
(2) Pay attention to maintaining negative pressure suction, replace the drainage device in time, and pay attention to aseptic operation when replacing it.
(3) Remove the drainage tube in 3 to 5 days.
5． Disease Observation When observing the skin flap, it should be compared with the adjacent skin tissue, and judgments should be made based on the color of the skin, finger pressure response and tension. The observation site should be the distal end of the flap. The distal end of a single-pedicle flap is the farthest edge from the pedicle. The distal end of a double-pedicle flap is the middle section of the flap. Do not allow the pedicle to be compressed, twisted, or stretched. . Observation was performed every 1 hour on the 1st to 2nd day after operation, and every 2 to 4 hours on the 3rd to 5th day after operation.
(1) Skin flap color: Insufficient arterial blood supply. The skin color becomes pale and gradually withers. Poor venous return, the skin color gradually changes, red → purple → cyanosis → purple black → blisters. After the blisters appear, use a sterile syringe needle to extract the exudate, and the scabs will fall off on their own. After free flap transplantation, attention should be paid to keeping the room temperature at around 28°C. Avoid vasospasm caused by low temperature, which may lead to blood supply disorder of the skin flap.
(2) Acupressure reaction: Use your fingers to gently press the transplanted skin flap to make it pale, and then quickly remove your fingers. Normal skin color turns rosy within 1 to 2 seconds. If the filling time is shortened, it indicates poor venous return. If the response is slow and exceeds 5 seconds, it indicates poor blood supply and the possibility of arterial embolism. The doctor should be notified in time for treatment.
(3) Skin tension
Under normal circumstances, the skin flap will be slightly swollen within 2 to 3 days after surgery. The degree of swelling will increase significantly when venous thrombosis occurs, and the swelling will not occur when the arterial blood supply is blocked. Obviously, the skin lines are increased or even shriveled.
6． Medication care: Administer medications as directed by the doctor and maintain smooth intravenous infusion. Pay attention to the reactions after taking the medication, such as infusion reactions, rashes, coagulation disorders, etc. If there are any abnormalities, stop the infusion immediately and notify the doctor in time.
7. The stitches are removed according to different parts, and they are usually removed in about 10 days.
Discharge Instructions
1. Feed a nutritious and easily digestible diet.
2. Bath regularly and keep your skin clean and dry.
3． Pay attention to moderate activities in daily activities.
4. Functional exercise may cause numbness or local dullness in the short term. Patients should be reminded to strengthen self-protection to prevent burns, frostbite and lacerations.
5． Regular follow-up examination
6. Prevent skin flaps and free flaps to be wrapped with elastic dressings or wear elastic sheaths 2 weeks after transplantation to avoid edema and scar hyperplasia.