1, supplies and preparations
1. Explain the treatment plan, specific plan and expected effect to the patient again, obtain the consent and cooperation, explain it to his organization or family if necessary, and sign the operation consent form. Those who need blood transfusion should sign a blood transfusion consent form.
2. Check whether all kinds of examinations (including general physical examination and necessary examinations), diagnosis and operation schemes are complete.
3. Patients with large surgical scope should take a bath or scrub before operation. If the head needs to be bandaged during the operation, you should have a haircut and wash your hair. The day before the operation, shave the hair in the operation area (don't scratch the skin), wash it with soap and water, dry it and wipe it with 75% ethanol.
In addition to the general surgical routine, the scope of skin preparation is as follows: ① prepare the skin of face, neck and upper clavicle for facial surgery, without shaving eyebrows, cutting short nose hair and washing nostrils; ② Prepare the whole thigh, ipsilateral lower abdomen and thigh in the thigh skin donor area, and shave go to the pubic hair. If the skin graft is cut below the half drum (100cm2) and far away from the groin, it is not necessary to shave pubic hair as appropriate, but it must be indicated in the doctor's advice; ③ A large area of skin must be prepared for the chest, back, abdomen and upper arm as a skin donor area, which should be 4-5 times larger than the skin incision area.
4. The day before the operation and the morning of the operation, the resident in charge should check again whether the patient has upper respiratory tract infection, whether there is infection focus in the operation area and whether the skin preparation is perfect.
5. Tetanus antitoxin should be injected before the old wound is repaired, but those who have received toxoid immunization within 3 years only need to inject toxoid 1 time.
6. Use drugs according to anesthesia routine before anesthesia, and contact the anesthesiologist in time under special circumstances.
2. Methods and contents
(a) disinfection towel (leaflet)
1. Disinfect with 0.5% chlorhexidine solution, 0. 1% bromogeramine solution or 2.0% iodine tincture, and then scrub repeatedly with 75% ethanol. In facial surgery and disinfection of skin donor area, we should avoid using iodine tincture and other irritating disinfectants. If necessary, scrub the local area with 3% hydrogen peroxide solution and the same amount of soapy water, then rinse it with sterile saline, and finally dry it with sterile gauze. If skin is needed, disinfect the donor area first and then the recipient area.
2. Towels (sheets) should be tightly covered and the head, face and neck should be operated. If necessary, sterile towels should be stitched and fixed on the skin around the operating field. Sterile sheets should have at least two layers. When transplanting distal flap, attention should be paid to avoid the pollution of operating field by moving limbs during operation when laying sterile towel.
(2) Incision and hemostasis
1. Draw the skin incision design line first.
2. The incision should be in the direction of dermatoglyphics, and the vertical dermatoglyphics incision should be avoided; When you need to cross the dermatoglyphic pattern, you should change the direction and make it zigzag. Facial incision should be cut along dermatoglyphics in a hidden place.
3. Stop bleeding with mosquito forceps and tie a knot with thin thread. When oozing blood, warm saline gauze can be used for compression. Microelectrocoagulation can also be used to stop bleeding.
(3) suture and drainage
1. Layered suture generally adopts fine needle and thin thread, which requires accurate alignment of all layers of tissues, no dead space, high tension and no local blood supply.
2. When a wide range of wounds, wounds that may accumulate fluid or leave a dead space, wounds that may be contaminated or infected, and bleeding are unsatisfactory, drainage strips should be placed and negative pressure suction devices should be connected if necessary.
(4) Bandage and braking
1. Pressure dressing method (taking skin graft as an example): cover the skin graft with a layer of oily gauze, add 6-8 layers of wet gauze according to the size and shape of the skin graft, and add a lot of loose gauze and cotton pads for pressure dressing to make the skin graft closely contact with the wound. Uniform pressure and tight dressing are needed. In the part that is not suitable for direct pressure dressing with bandage, the method of suture wrapping and pressure fixation can be used (referred to as packing and pressure fixation, the skin graft is sutured to the edge of the wound, and several pairs of long lines are left around, and the bandage is tied and fixed).
2. Brakes can be made of adhesive tape, splint and plaster. Prevent the blood supply disorder caused by too tight dressing or the damage caused by gypsum compression.
3. Post-operation management
(1) postoperative treatment
1. The position is the same as that of general surgery, but the affected part must be raised and placed in a comfortable position.
2. People who can't eat normally after jaw fixation can insert a rubber tube in their mouth and feed it with a pump or funnel. Individual patients need nasal feeding. This kind of patients and patients with multiple staged operations should strengthen nutrition.
3. Sedatives and analgesics should be given as appropriate to patients with limbs fixed in special positions on/0/-3 days after operation if they feel uncomfortable or painful.
4. Check whether the dressing is soaked, too tight, loose and displaced, whether the plaster fixation is true, and whether there are any compression symptoms. Whether the negative pressure drainage device is tightly connected, whether it leaks or is loose. If found, it should be handled in time.
5. If there is infection, check the wound in time and make necessary treatment.
6. Antibiotics can be used in the following situations.
(1) The fresh incision may be infected or the fresh wound may be sutured for skin grafting in the first stage.
(2) After skin grafting for granulation wound, chronic ulcer and infectious tumor, select effective antibacterial drugs with reference to preoperative bacterial culture sensitivity test.
(3) Bone, cartilage, fat, fascia and other tissue transplantation, and other substitutes.
(4) Surgery with large operation scope, complicated operation and long time.
(2) Post-treatment
1. Physical therapy and physiotherapy should be carried out in time after the incision is healed to promote the softening and absorption of scar and the recovery of joint function.
2. Care should be taken to prevent burns, frostbite and other injuries before the skin graft, skin flap and skin tube after transplantation recover their senses. Before leaving the hospital, you should explain clearly to the patients and guide them on the methods of functional exercise.
3. In order to prevent scar hyperplasia in the skin graft area and the skin donor area, elastic bandages should be applied under pressure for more than half a year when conditions permit, especially for the lower limbs. Or radiotherapy.
4. After the course of treatment, we should continue to observe the long-term effect, check 1 time every 3-/2 months, and make records or take photos until the surgical effect is completely stable.
4. Analysis of the success rate of cosmetic surgery
1. Is the hospital normal?
The success rate of cosmetic surgery is mostly related to the irregularity of hospitals. The success rate of regular hospitals is very high, although it is more expensive. However, once a fault case occurs, it is easier to maintain and claim compensation later than private hospitals. In addition, the qualifications and experience of medical practitioners are also very important. Doctors in some private hospitals are experienced and can also do cosmetic surgery. But these doctors are a few elites, and most of them are beauty salons. It's good to listen to people who are not qualified as doctors in beauty salons.
2, whether the drug is qualified
Beauty drugs usually have contraindications and side effects. If you use irregular drugs or even fake drugs in places where you have surgery or beauty, it is easy to ruin your face. You know, the prices of real drugs and fake drugs are very different. If the other party sells you fake medicine at the price of real medicine, you will make a profit. Many places will take risks for the benefit and make and sell fake products. Generally speaking, you should respond rationally to each other's injection promotion. Unless you have the necessary needs, then you should first. Going to a formal place is less likely to meet a boy than going to an informal place, but it doesn't mean that there is no fake medicine in a formal place. Be careful.
3. Is the operation reasonable?
Discuss the position of plastic surgery before the operation. Whether the operation is reasonable depends not only on the doctor's advice or what you want, but also on your own personal situation. If the doctor didn't tell the patient what the operation was not suitable for before the operation, she suggested a better way to avoid the risk, but with the idea that there should be no problem, she found that the operation failed. This is an unreasonable operation. Some people are allergic to something, so the patient should be allowed to agree before the operation.
4. Whether it is an aesthetic standard.
The aesthetics of a plastic surgeon determines whether the beautiful women under his command can retain their own characteristics. Many failed cases are also related to the disharmony between the plastic surgery part and the original part, so some plastic surgeons will go to plastic surgery again and again, hoping to be more harmonious and beautiful, but I don't know, at this time, because the doctor's aesthetics only stays in the standard aesthetic stage, the plastic surgeon is more powerful than the ordinary plastic surgeon, that is, he can find the original beauty of the plastic surgeon. Modifying the defect can make it more attractive, and its appearance can be realized by going up a flight of stairs. Unqualified cosmetic doctors come step by step, and people will see the traces of cosmetic surgery after cosmetic surgery, mostly because the doctor's aesthetics are not up to standard and his appearance is not harmonious.
5. Is plastic surgery addictive?
Actually, I think cosmetic addiction here can be divided into two categories. One is that they think plastic surgery is very effective, and then there is nothing they can do. Their hearts are full of dissatisfaction with themselves and their desire for self-confidence after plastic surgery. The other is that they think the cosmetic effect is not good, and then they have to go for cosmetic surgery. As a result, they all felt worse. Their hearts broke down and they really regretted it. I think the whole thing is not as good as the original, which also shows my recognition of myself and my fear after plastic surgery. But no matter what kind of plastic surgery, it depends more or less on plastic surgery, just like smoking addiction, but the side effects of plastic surgery will gradually become prominent with the increase of the number of times, especially in the final stage of plastic surgery, plastic surgery patients will have a fake face, and even more frightening is that some plastic surgery patients will directly disfigure their faces.
6. Failure is more successful
The success rate of cosmetic surgery is high, but the cases of failure are obviously more attractive to people. Although we should sympathize with these people who have failed in cosmetic surgery, the reality is that most people are more inclined to laugh at them, and successful cases are just watching the fun. If you see the side effects of plastic surgery, you may want to change someone else's "deserved it" as a summary, so even if the success rate is higher, what people see is still failure. In the final analysis, there is no right or wrong in cosmetic surgery, but people have different ideas. Most cosmetic failures are due to the wrong choice. Many failures can be avoided if you can choose those options with high success rate. If you just want to take advantage of your advantages and fail, you might as well choose not to have plastic surgery, which can 100% avoid the risk of failure.