胸脐皮瓣移植修复手、腕部深度创面13例护理体会

1998年以来，我们将胸脐皮瓣移植修复手腕部深度烧伤创面11例，经精心护理，效果满意。现报告如下。     

大型胸脐下腹游离皮瓣联合修复双下肢Ⅲ度烧伤创面

目的：临床分析29例患者双下肢Ⅲ度烧伤创面大型胸脐下腹联合游离皮瓣同时修复的结果。方法：本组男20例，女9例，共烧伤创面32处，早期行局部减张术，术前、术后采用小分子右旋糖酐及血管活性药物处理。结果：皮瓣全部成活，大部分皮瓣感觉功能恢复，且转移灵活、外观好，优于其他皮瓣。结论：大型胸脐下腹联合游离皮瓣同时修复双下肢Ⅲ度烧伤创面取得满意疗效。     

1例胸脐皮瓣联合腹股沟皮瓣移植修复右前臂毁损伤的护理

游离皮瓣移植是修复皮肤软组织大面积缺损的有效方法之一.2004年3月26日,我科对1例右前臂毁损伤伴有血管神经肌肉损伤、骨折、骨与关节外露的患者行吻合血管的胸脐皮瓣联合腹股沟皮瓣移植术,经系统精心护理,皮瓣成活,保全了患者的肢体,最大限度地恢复了肢体的功能,现将护理报告如下.     

胸脐皮瓣游离移植修复四肢大面积软组织缺损患者的护理

总结24例胸脐皮瓣游离移植修复四肢大面积软组织缺损患者的护理.术前充分做好患者的心理护理,急诊患者多情绪焦虑、急躁,用简短易懂的语言做好宣教,以稳定患者情绪;经久不愈的患者均有较重的精神和经济负担,积极讲解手术的优点和可行性.做好皮肤准备,急诊患者在麻醉下,用软毛刷蘸肥皂水反复刷洗伤口周围皮肤,将污染创面变成相对清洁创面;注意观察皮肤有无疖肿等异常情况.术后严密观察移植皮瓣血运,做好静脉血管危象、肿胀的观察处理;积极预防血管痉挛、供区切口感染的发生.保持正确的体位,患者创面较大,不宜侧卧位,予臀下垫糜子垫以预防压疮.指导循序渐进康复训练,足底移植皮瓣患者下地活动时穿宽松、软底拖鞋,在他人的搀扶下行走.本组患者术后3～7 d出现静脉血管危象3例,其中1例皮瓣远端部分坏死,另l例完全坏死,1例成活,其余21例皮瓣全部成活.     

游离胸脐皮瓣移植修复四肢皮肤软组织缺损的术后护理

总结5例游离胸脐皮瓣修复四肢皮肤软组织缺损的术后护理。认为重点是严密观察皮瓣的血供情况,及时发现、处理血管危象,是保证皮瓣存活的关键;保证充足血容量,重视呼吸支持及一般护理,给予心理支持,做好用药护理,是手术成功的重要因素。     

胸脐皮瓣移植在儿童大面积软组织缺损中的应用

对于儿童四肢大面积软组织缺损，因局部皮瓣转移不适于大面积修补，而单纯游离植皮后易造成大面积疤痕，影响外观及功能，故治疗上较困难。我院自1995～2004年间应用游离胸脐皮瓣经吻合血管后修复儿童软组织缺损23例，取得较满意的效果，现报告如下。     

胸脐皮瓣修复小腿创面的护理体会

目的探讨健侧胫后血管桥接胸脐皮瓣移植修复小腿较大创面的围术期护理的重要性。方法对9例小腿巨大创面患者采用健侧胫后血管桥接胸脐皮瓣移植修复,进行周密的术前准备和有效的术后皮瓣的观察和护理。结果术后皮瓣均全部存活,术后随访3个月~2年,皮瓣色泽良好,质地柔软。结论在应用健侧胫后血管桥接胸脐皮瓣移植修复小腿较大创面的过程中,除术者术中操作外,做好围术期护理工作是手术顺利进行的关键,尤其是做好心理护理、基础护理以及术后严密观察皮瓣血液循环,及时发现动静脉危象,为手术成功提供重要的保证,可有效提高皮瓣成活率。     

手腕部电烧伤皮瓣移植术后的功能训练

手腕部电烧伤将难以保留的肌腱、血管、肌肉清除后选用胸腹部、髂腹股沟皮瓣覆盖。术后进行有效的功能训练。可以最大限度地保护手腕部的功能。对27例皮瓣移植术后患进行功能训练，取得良好疗效。     

胸脐皮瓣移植修复小儿下肢组织缺损12例围术期护理

胸脐皮瓣具有切取方便、部位隐蔽、修复面积大、供区处理简单等优点,此皮瓣较多地应用于组织大面积缺损的修复.胸脐皮瓣移植修复小儿下肢组织缺损很多方面与成人相似,但也具有特殊性,风险大、手术复杂、并发症多、治疗及护理要求高等.     

腕部电烧伤创面修复的临床分析

目的腕部电烧伤创面修复的最佳皮瓣选择。方法将1994—2008年间应用皮瓣修复腕部电烧伤创面64例72个肢体分成两个组进行比较分析,一组为腹部带蒂皮瓣修复,另一组为局部轴型皮瓣及游离皮瓣修复。结果两组患者在伤情严重性、年龄和手术时间等方面均基本相同,但两组患者创面愈合率及深部重要组织保存,以及严重并发症发生有很大差异（P〈0．01）。结论用局部轴型皮瓣和游离皮瓣修复腕部电烧伤较用腹部带蒂皮瓣修复有明显优越性。     

异种(猪)无细胞真皮基质与自体微粒皮复合移植修复深度烧伤创面的实验研究

目的　观察异种 (猪 )无细胞真皮支架与自体微粒皮加同种异体皮复合移植修复全层皮肤缺损的效果。方法　 4 8只 SD大鼠背部全层皮肤缺损创面 ,分别行异种 (猪 )无细胞真皮支架与自体微粒皮移植(复合皮组 )和单纯微粒皮移植 (对照组 ) ,术后定期观察创面愈合情况并行创面愈合率和收缩率的计算 ,同时取创面组织进行组织学观察。结果　复合皮组的创面愈合情况良好 ,未见明显挛缩 ,皮肤弹性较好 ,两组异体皮成活情况及创面愈合情况相近 ,但是复合皮组创面收缩率显著低于对照组。组织学观察复合皮组上皮化良好 ,胶原纤维排列有序 ,基底膜结构完整。结论　异种 (猪 )无细胞真皮支架与自体微粒皮复合移植能修复全层皮肤缺损 ,改善创面愈合质量。     

Mitral valve repair

Diseases that affect the mitral valve include mitral regurgitation, mitral stenosis, rheumatic heart disease, and cardiomyopathy. The results of diagnostic procedures are used to identify and confirm mitral valve disease, evaluate the patient's anatomy, and determine the severity of the disease. After the patient is prepared for surgery, the surgeon performs an intraoperative transesophageal echocardiogram and the patient is placed on cardiopulmonary bypass. A repair procedure (eg, annuloplasty, slidingplasty, chordal repair/transfer/replacement, valve replacement) is performed depending on the patient's specific anatomical abnormalities.     

Posttraumatic stress disorder in electric burn patients

It was hypothesized that burn injuries electric in origin may have a poor prognosis for rehabilitation and return to work. Ten electrically injured burn patients were compared to seven patients whose burns were nonelectric, after all 17 had shown clinically significant emotional problems during rehabilitation. Results of psychological tests from both groups were also compared to results in three other groups: psychiatric, chronic pain, and blepharospasm patients. Results indicated that patients with electric burns had the most severe psychopathologic symptoms and the least likelihood of returning to work. Only the factor of educational background was predictive of degree of psychological distress, prognosis for returning to work, and response to psychological intervention. Results are discussed within a one-trial aversive conditioning paradigm potentially unique to electric injuries.     

腹部带蒂皮瓣修复手腕部烧伤患者的护理

笔者报道97例手腕部烧伤患者采用腹部带蒂皮瓣移植修复术的护理。强调术前心理护理和体位锻炼，术后着重观察皮瓣血运和冲洗管护理，协助进行恢复性训练。患者均取得良好的治疗效果。     

Transcatheter valve repair/implantation

Real time 3-dimensional transesophageal echo is a relatively new technology that enables online imaging that is highly accurate and precise for evaluating cardiac structures. Moreover, this methodology allows for accurate online guidance of interventional cardiac procedures for structural heart disease. In this report, we describe the use of real time, 3D transesophageal (TEE) for aortic valve replacement with percutaneous, bioprosthetic valves as well as for transcatheter mitral repair with the MitraClip device. For each procedure, we describe 3D evaluation of valvular structures prior to the procedure, and how 3D imaging is used to guide the procedure as well as to assess the results of the procedure. Use of 3D TEE has proven to be a substantial advance for evaluating patients prior to percutaneous heart valve procedures and especially for guiding and monitoring percutaneous, transcatheter heart valve procedures.     

Atrial fibrillation and mitral valve repair

Atrial fibrillation (AF) is present in 30–40% of patients presenting for mitral valve surgery. In patients undergoing mitral valve repair, the presence of AF may be associated with increased mortality and morbidity and this is also the case in patients in whom AF persists postoperatively. Advances in understanding the pathogenesis of AF led to techniques that include both mitral valve repair and ablation of AF. The concomitant surgical treatment of AF during mitral surgery has become a commonly performed procedure, which was shown to be safe and which may improve the outcome for patients. AF after mitral valve replacement is an accepted indication for anticoagulation, but the data supporting anticoagulation in patients after mitral valve repair who convert to sinus rhythm are sparse. This article reviews the available data regarding outcomes of mitral repair and how they are influenced by AF and its therapy.     

An image of mitral valve repair

Mitral regurgitation is a severe problem of the mitral valve mechanism caused by many factors, including ischemic and nonischemic cardiomyopathy, inflammation, degeneration and others. Regardless of the cause of valve dysfunction, many changes in surgical approach have been undertaken. The pioneering work of Carpentier led to the era of mitral valve reconstruction a few decades ago. Understanding the different techniques applied in several pathoanatomic settings is of major interest. This review summarizes the indications and results of this specific surgical procedure in the setting of ventricular dysfunction by different causes.     

An image of mitral valve repair

Mitral regurgitation is a severe problem of the mitral valve mechanism caused by many factors, including ischemic and nonischemic cardiomyopathy, inflammation, degeneration and others. Regardless of the cause of valve dysfunction, many changes in surgical approach have been undertaken. The pioneering work of Carpentier led to the era of mitral valve reconstruction a few decades ago. Understanding the different techniques applied in several pathoanatomic settings is of major interest. This review summarizes the indications and results of this specific surgical procedure in the setting of ventricular dysfunction by different causes.     

高压电击伤血管损伤的影像学研究进展

随着现代医学影像技术的发展,诊断高压电击伤血管损伤的影像学方法主要有:动脉造影、数字减影血管造影、计算机断层血管成像、磁共振血管成像、放射性核素血池显像、彩色多普勒超声血流成像技术等。其中彩色多普勒超声血流成像技术以其安全、准确、高效、无创、重复性强等优点,可常规用于高压电击伤血管损伤的诊断及术后疗效监测。