Indications, advantages, disadvantages and risks of the dilatation technique
Indications
Soft tissue skin expansion can provide “extra” skin tissue for repairing defects, solving the problem of insufficient tissue in the donor area, including: repairing large scars and defects, repairing wounds after excision of superficial lesions such as tattoos and benign tumors, reconstructing organs such as scalp, breast, auricular and nasal defects, expanding and growing nerve defect segments after The procedure can be performed by anastomosis, reconstruction of nerve function, provision of skin pieces or pre-purchased flaps for transplantation, etc. It can be considered whenever various parts of the body need to be repaired or reconstructed and the local donor area is insufficient. This technique can replace lamellar scars with linear scars, reducing the size of the scar and improving its appearance.
It is not suitable for patients who are uncooperative or incapable of self-control, or for those who have had radiation therapy to the area to be dilated and have poor blood flow, contamination or inflammation.
Advantages of expander treatment
Compared to traditional skin implants, skin expansion provides new skin of similar color, texture, thickness, and elasticity to the defective area for repair without additional scarring of the donor area.
Disadvantages and risks of expander treatment
1. The procedure needs to be completed in two stages, which takes a long time, and the expansion period may be 3-6 months.
2.Since the dilator is an implant, infection and rejection may occur during the dilatation period, making the dilator exposed and the skin broken.
3.Temporary nerve compression paralysis or pain may occur at the dilated site, which may recover slowly after the dilatation is completed and does not require special treatment. The nerve pulling pain is generally considered to be related to the nerve pulling by the dilatation, which can be improved by nerve closure, reduction of water injection, and prolonging the dilatation time.
4.A small amount of pink or yellow clear and odorless tissue fluid flowing from the orifice within one or two months after the external dilator is a normal phenomenon, and the orifice must be cleaned regularly every day. Early injection of water in the head and face dilator can flow out black old blood must be squeezed out as soon as possible to prevent infection.
5, skin blisters. For the expansion process of a single injection of too much water caused by skin blood flow disorders. Can be relieved by withdrawing a small amount of perfusion fluid to temporarily delay expansion.
6, scalp expansion patients may occur osteophytes, causing rupture of the dilator during expansion, must be replaced dilator. Postoperative periosteal hyperplasia bulge around the dilated area,. Generally, it can be basically eliminated after six months.
7, skin incision cracking. Because the dilator is often buried in the original scar incision, to prevent new scars in the good skin, so the scar skin may be incision healing poorly, or improperly fixed after surgery bandage mouth pressure caused by incision cracking.
8, skin adnexitis. Occurs in the middle of the scalp expansion, manifesting as typical folliculitis, more densely distributed, local warm water soft towel cleaning, and disinfection with iodophor red papules can be gradually eliminated.
9, some patients exist after a period of expansion of the skin gradually thinning, playing water pain, can not be further expansion of the situation, must be closely observed by regular follow-up.
10, early injection of water too quickly and easily lead to local skin pallor, blood flow disorders, further formation of capillary hyperplasia skin surface redness, further occurrence of vascular embolism, local skin rupture necrosis, dilator exposed.
Dilator buried in the post-operative water injection period care instructions
During the postoperative water injection, water injection should be strictly aseptic to avoid medically-derived infection. Generally, the first water injection must be performed within 2 weeks after surgery, and the water injection and the removal of stitches should not be performed on the same day, preferably more than two days apart. Failure to perform the first water injection for more than two weeks may result in the formation of the peritoneal sac and the dilator not being able to play. The first three water injections can be done as much as possible without painful skin sensation so that the dilator can be rounded and propped up to prevent the dilator from folding into an angle and topping the skin. The amount of water injected after reaching the dilator volume is generally about 10%-15% of the rated capacity of the dilator, which can be decided according to the dilation flap acupressure congestion response and the patient’s pain. After water injection, skin acupressure congestion response 4-5 seconds to recover, no pain or slightly pain can be, such as dilated flap 15-20min is still pale, should be appropriate amount of partial withdrawal of saline. Usually injected once in 3-5 days. The speed of skin expansion: children should be fast, adults should be slow, abdominal skin relaxation should be fast, forehead and extremities should be slow, if the skin after transplantation or secondary expansion of skin, the expansion speed should be slowed down.
After water injection, disinfect the built-in pot puncture site again. If it is an external pot, the catheter should be disinfected again at the exit of the skin penetration, and the exit should be closed with alcohol cotton balls. If the cotton ball is fixed with adhesive tape, it should be pasted on the normal skin outside the dilated flap. It is strictly forbidden to paste the waterproof band-aid directly on the dilated flap, otherwise the skin of the paste site will be broken or allergic due to poor permeability.
Protect the area where the dilator is implanted from pressure and collision, and adjust the sleeping position when sleeping. Young children and children should know that their parents should look after them closely to avoid playing, wrestling, playing hide-and-seek, and to prevent them from falling from the bed. In summer, take measures against mosquitoes and mosquitoes to prevent the expansion flap from becoming infected and breaking down due to mosquito bites. In winter, pay attention to warmth, forbid long-term outdoor, avoid frostbite of the dilated flap, wear cotton clothes to avoid rupture of the dilated flap caused by friction of chemical fiber and other clothing. If there is acne formation on the flap, suspend water injection and apply iodophor or mupirocin ointment to the acne. When cleaning the skin around the dilator, it is strictly forbidden to leak water into the external pot or the percutaneous outlet of the drainage tube.
Postoperative care instructions for dilator removal
Flap care: postoperative dressing of the dilator flap is one of the important aspects of successful surgery. Moderate postoperative pressure can prevent hematoma and also play a role in shaping, and the head and face are usually fixed with headgear for 1-3 months, which can help shape the chin and neck angle and reduce facial hematoma. However, too tight dressing wrapping can easily lead to poor flap blood supply and blocked venous return, and if the dressing wrapping is loosened, the dressing wrapping pile will turn and change the positioning point of the wrapping, which will directly affect the survival of the flap. Therefore, the dressing wrap should be closely observed in the operating area, and the tip wrap should be strictly forbidden to be too tight to prevent pressure in order to maintain blood supply. Observe the flap blood flow closely, and observe the color, swelling, temperature and tenderness of the flap from the observation hole reserved every hour for 2 days after surgery, and ask the physician to give treatment in time if abnormalities are found.
Drainage tube care: Keeping the negative pressure drainage unobstructed is necessary to ensure the success of the operation. Smooth negative pressure drainage not only allows adequate drainage of blood in the operative area, but also, importantly, allows for certain adsorption of the expanded flap to the subcutaneous tissue. It is important to ensure the airtightness and patency of negative pressure drainage to prevent folding or dislodging. The negative pressure drainage bottle should be replaced in time to ensure the negative pressure effect. Observe the change of drainage fluid and record the amount of drainage. If the drainage fluid continues to be bright red and exceeds 100ml an hour, the possibility of traumatic hemorrhage should be considered and the physician should be notified promptly.
Dietary care: eat reasonably, prohibit spicy and stimulating food, give high-calorie, high-protein, high-vitamin diet, and enhance nutrition to improve wound healing ability.
Indications and secondary treatment for expansion flap scar augmentation repair
Expansion flaps require additional auxiliary incisions to increase the angle of transfer and expand the repair area of the flap when transferring the repaired wound, thus additional scars will be formed. If the postoperative scar has obvious redness, bulging and widening, and does not subside after six months to one year, intra-scar injection or scar-cutting plastic surgery is feasible, which can usually be done on an outpatient basis, and the repair methods include scar excision, reshaping, local flap transfer, etc.
Cases that require timely treatment or return to the hospital
1.Leakage of expansion pot
If it is external, the injection tube can be clamped shut with a flat-headed frame, or the clamp for shutting off the rehydration fluid and changing the site clamp each time to prevent the clamp from breaking the tube. If it is built-in, you need to go back to the hospital to change to external.
2.Dilator rupture or leakage
The performance of external is that a large amount of clear liquid flows out from the mouth of the tube; built-in performance is that the original tight skin surface is suddenly loose.
Treatment: go back to the hospital to replace the dilator, generally 1cm-2cm incision under local anesthesia can be replaced, infants and children need general anesthesia.
3.Expansion of skin problems
If the injection is too fast, the expansion of the skin stretch marks, red blood, the need to slow down the injection of water and water injection speed, after the skin to adapt to the expander and then slowly increase the amount. If the injection is too fast, the dilated skin will become red in the early stage, then the dilated skin will become thin and green and eventually black, resulting in the exposure of the dilator and failure of expansion.
4.Dilator infection
If the dilated skin is red and hot and accompanied by pain, or the canal mouth outflow of purulent or turbid liquid, early antibiotics can be taken to treat the infection, such as two or three days after no improvement in the need for intravenous application of antibiotics, such as still can not control the infection need to go to the hospital for rehydration and flushing treatment, until the body temperature returns to normal outflow of liquid is clear. It usually takes one to two weeks. If the infection cannot be controlled by flushing, the dilator may need to be removed.