Objective To explore the influence of nursing on free skin grafting in dermatology, and to provide effective nursing measures for clinical nurses, so as to alleviate patients' pain, reduce postoperative complications and improve the survival rate of skin grafting.

Methods From April 1965 to September 1965, 65,438+026 patients with free skin grafting in our department were retrospectively analyzed. They were randomly divided into observation group (65 cases) and control group (665,438+0 cases), and the patients in the observation group were given postoperative hospitalization observation and comprehensive nursing. Due to some special reasons in the control group, the survival and postoperative complications of skin grafting in the two groups were observed after intervention. Among them, the survival rate of skin graft accounts for more than 2/3 of all skin grafts, most of which survive, and the survival rate of skin graft accounts for less than 1/5, which is considered as necrosis.

Results After in-hospital observation and comprehensive nursing, 98% of the patients in the observation group survived by skin grafting, while 75% of the patients in the control group survived by themselves after discharge. The results showed that the survival rate score of the observation group after nursing intervention was higher than that of the control group (P < 0.05), and the life satisfaction was high.

Conclusion Careful health education and comprehensive nursing before and after free skin grafting can greatly improve the survival rate of skin grafting and reduce the probability of complications and adverse reactions.

Keywords: nursing; Dermatology; Free skin grafting

Free skin grafting is a cosmetic surgery for skin problems. It is to cut off part or all of the thickness of human skin from one place, completely separate it from the body, transplant it to another place, re-establish blood circulation, continue to maintain its vitality, and achieve the purpose of repair. The donor skin needs a new blood supply from the recipient to survive. Under normal circumstances, the probability of successful autologous skin transplantation is high, but some skin grafts do not survive. It is possible, mainly applicable to.

Skin transplantation is an amazing prelude to the rapid development of plastic reconstruction surgery in the second half of 19 century.

1869 Necker in Paris removed the epidermis of 1mm2 from the upper limb of the patient and transplanted it to the wound. After a few days, the epidermis grew to the edge of the wound and healed, which he called? Epidermal transplantation? [ 1]。

1 objects and methods

1. 1 research object

126 patients all underwent free skin grafting in the dermatology department of our hospital from April 20 12 to September 20 12.

There were 68 males and 58 females, aged 24-76 438 0 years.

65 patients in the observation group were all inpatients in our department, while 665,438+0 patients in the control group chose home care for special reasons. All the patients in this group are in line with the free skin grafting treatment in dermatology.

Statistical analysis showed that there was a significant difference in the survival rate between the two groups (P

1.2 research methods

26 patients with/kloc-0 were randomly divided into two groups, including 65 patients in the observation group and 6 patients in the control group. Both groups were treated with antibiotics, the observation group was given comprehensive nursing measures, and the control group was given self-care measures.

The timing of skin grafting is 1. 2 1

The patient's general condition should be good, and there are no surgical contraindications. If anemia and hypoproteinemia exist, they should be corrected in time, and diabetes and abnormal liver function should be strictly controlled.

1.2.2 preoperative preparation of donor and recipient areas

According to the routine operation, prepare the skin before operation to protect the skin source.

If the skin area is a granulation wound, Qin Ying should change the dressing a few days before operation and apply it with antibiotic solution to reduce secretion, and there should be no streptococcus pyogenes on the wound [2].

1.2.3 skin transplantation

Under the aseptic technique of local anesthesia, a layer of skin graft was peeled off from the skin donor area with a roller peeling knife, and then spread on physiological saline gauze, cut into stamps of 0.3-0.8cm [3], transplanted to fresh granulation lesions one by one, stitched and fixed, covered with oil sands, pressure-bound with broken physiological saline gauze, fixed with bandages and plaster, and observed the survival state of skin graft for 5-7 days [4].

1.2.4 donor site care

After operation, the donor site of the limb should be bandaged frequently, and the dressing should be kept clean and dry. Generally, the external dressing is changed 7- 10 days after operation, and the donor site is covered with oil sand to stop bleeding. If there is oozing blood or peculiar smell, check it in time to avoid replacing the donor site gauze before healing, so as to avoid bleeding and infection [5].

1.2.5 care of skin area

Pressure dressing is needed, and the pressure should be appropriate and even to prevent the skin graft from shifting. Expose the toe end of the skin as much as possible to observe the blood supply and inflammatory reaction of the skin. After operation, rest in bed and brake, raise the limb of skin graft, reduce local bleeding and facilitate venous return; Intravenous injection of antibiotics, hemostatic drugs, etc. Please do not remove the plaster bandage at will after operation; Closely observe whether the external dressing has exudation, blood supply to limbs, pain in skin graft area, elevated body temperature, redness and swelling around, cyanosis of limbs, pallor, etc. , and report to the doctor in time. After operation, you must eat foods with high protein and vitamins, such as fish, meat, eggs and beans, to avoid spicy and irritating foods [6].

1.2.6 discharge guidance

Two weeks after stitches are removed, you can wash it with neutral soap every day, dry it after washing, and apply vaseline or moisturizer for six months to one year to avoid chapped skin. Avoid the sun for half a year to avoid pigmentation in the skin graft area and donor area. If there is redness, swelling, fever, pain or abnormal secretion, see a doctor in time.

1.3 statistical method

Descriptive and inferential statistical methods were used to collect data, and SPSS 16.0 software was used for а=0.05 level test, P

Two results

2. 1 Comparison of skin graft survival rate after intervention

After treatment and nursing, the survival rate of skin grafting in the observation group was higher than that in the control group, and the difference between the two groups was statistically significant (P < 0.05).

3 discussion

Skin grafting is the most basic, useful and commonly used surgical method in surgical treatment.

Clinically, it is often used to remove huge tumors, relieve scar contracture or in various injuries. This kind of operation requires high requirements, such as adequate design and preparation before operation, strict aseptic and non-invasive techniques during operation, careful and patient operation, logistical inspection and careful observation, so that the survival rate of skin grafting can be high, the wound healing scar after operation is small and the color is close, and the final operation can be successful and achieve the expected purpose.

On the basis of free skin grafting, comprehensive nursing intervention was carried out, including: ① psychological nursing and psychological support treatment before operation to rebuild patients' confidence and courage in life; ② Postoperative patient care, changing patients' coping style, actively cooperating with treatment, and making patients pay attention to postoperative care; (3) nutritional therapy is given to patients, and a diet with high protein and vitamins is adopted to improve the survival rate of skin grafting; ④ Give discharge guidance to patients when they leave the hospital, so that they are more aware of the importance of health. Through comprehensive nursing, the survival rate of skin grafting in the observation group was high.

Therefore, we think that comprehensive nursing is an important means to improve the survival rate of free skin grafting.

refer to

[1] Kong Fan. Progress and prospect of skin transplantation. China Journal of Surgery. 1985, 1 1.

[2] Liu Xuejun's clinical experience in treating granulation wounds with skin grafting beyond the scope. Pharmaceutical Preface. 20 12, 10.

[3] Tang Fuping. Nursing experience of free skin grafting. Journal of hydroelectric medicine. 2000，04。

[4] Gan, Zhou Xiuzhen, Roman et al. Nursing care of patients with free skin grafting. Journal of Nursing Science .2004, 1 1.

Xu weishi Modern burn therapy. Beijing. Beijing: (Surgical Edition) Science and Technology Press.1995,7.

Du Xinhui. Preoperative preparation and postoperative nursing of free skin grafting. Foreword of China Medicine .2008, 19.