Postoperative care and precautions for skin flap transplantation
1.Assist the physician to complete the preoperative examination.
2.Prohibit the operation of venipuncture and infusion in the donor area.
3.Guide the patient to practice using the bedside commode before surgery.
4.Finish the preoperative preparation and preoperative instruction according to the doctor’s prescription.
Postoperative.
1.Monitor vital signs until stable.
2.Lie in bed for 7-10 days after surgery, with the flap disposed in the correct position and not under pressure, and the limb of the donor area elevated 20-30℃ to facilitate venous and lymphatic return.
3, continuous light baking (60W) at the flap, keeping the light distance at 30-1250px to prevent local temperature from being too low, leading to vasospasm and thrombosis.
4, the flap’s blood flow observation: including: color, temperature, tension, capillary reaction time, pinprick or small incision blood release. If abnormalities are found, notify the physician for treatment in a timely manner.
5.Position and position of the affected limb: within 7-10 days after surgery, it is necessary to keep the limb lying down and to keep the flap free from pressure, and elevate the limb in the flap donor area by 20-30 degrees to facilitate venous and lymphatic return; after the flap is transferred and sutured, a thin pillow can be padded under the affected limb to prevent the affected limb from dropping and shifting and causing pain and pulling the flap to affect blood circulation.
6.Observation of condition.
1.Observation of vital signs is the same as that of amputated limb replantation.
2. Observation of blood flow of the flap: 4-7 times a day for 3-5 days after surgery, with the following items.
①Color
② skin temperature
③ skin flap tension
④capillary reaction time
⑤ Needle prick or small incision blood release test.
Under normal circumstances, within 2-3 days after surgery, the skin flap is mildly edematous, turns white when pressed, and turns red immediately after release. When the skin color is pale, skin temperature is reduced, flap tension is slightly low, capillary reaction time is prolonged, needle bleeding is not active, etc., suggesting insufficient arterial blood supply; when the skin color is purple-red or purple-black, skin temperature is increased, flap swelling is serious, there is tension blister, capillary reaction time is accelerated, there is dark red blood flow from the needle, bleeding is active, etc., suggesting venous return is blocked.
At this time, the following treatment should be performed.
①If cyanosis and congestion of the flap are found to be severe, it should be treated promptly and the tip should be observed for torsion and compression. If it is bleeding, loosen the dressing and correct improper fixation or remove a few sutures to reduce the pressure on the flap; if it is poor venous return, make a small incision to drain the bruise.
②If it is arterial spasm, use vasodilators, such as dipyridamole (Pansentin), tolazoline, low molecular dextran, poppyrine, compound salvia, etc.
3, the flap sensory recovery observation: postoperative flap exists sensory loss, recovery time is long, the recovery order is pain, touch, temperature sensation, temperature sensation recovery about more than 1 year after surgery, so before the recovery of sensation should pay attention to prevent trauma, especially to prevent burns and frostbite.
4. Closely observe the adverse reactions of postoperative anticoagulant drugs: the same as amputation reimplantation.
Main nursing issues.
1.Postoperative medication observation, especially the adverse reactions of anticoagulant drugs: such as whether there are bleeding spots and bruises on the skin and mucous membrane, epistaxis, and whether there is abnormal bleeding at the wound.
2, dietary guidance: general patients eat a high-protein, high-calorie, vitamin-rich, multi-fiber diet to promote healing of the incision and prevent constipation.
3.Strengthen basic care to prevent complications such as pressure sores, crushing pneumonia, urinary tract infections and lower limb venous thrombosis.
4.With good healing of the incision, the stitches were removed 12-14 days after surgery.
5.Guide the patient to functional exercise according to medical prescription.