足跟部软组织缺损皮瓣修复的围手术期处理

目的:探讨足跟部缺损行皮瓣修复的围手术期处理的内容、方法和疗效。方法:对21例足跟部软组织缺损行皮瓣修复术进行回顾性分析;术前对患者进行状况评估、心理调整、先期创面处理、皮瓣选择及术后皮瓣的观察、血管危像的处理等。结果:术后皮瓣全部成活,术后出现血管危像1例,早期发理处理后转好,2例皮神经皮瓣术后3 d出现小水泡,皮瓣略暗红,经部分拆线减压后好转,4例并发有低蛋白血症或贫血,高血压病和糖尿病患者伤口延迟拆线。结论:术前全身状况评估、积极创面处理、皮瓣的选择和修复、术后细致的观察、护理和合理用药是足跟部缺损行皮瓣修复围手术期处理的重要内容,是减少手术并发症、提高手术疗效的关键。

Perioperative management on the flap repairing of defect of skin and soft tissue on heel

Objective To explore the components and methods of the perioperative management on the flap repairing of defect of skin and soft tissue on heel.Method A retrospective analysis was performed in 21 patients with defect of skin and soft tissue on heel from January 2006 to October 2011,the flap repairing operation had been performed for these cases.The patients′ status evaluation,mental state adjustment and effective debridement were performed before the operation;the graft flap design and observation,crisis of blood vessel disposal,nursing and rational medication were conducted after the operation.Results All patients underwent the operation safely,and all flaps survived well.One case with spasm of blood vessel was found from postoperative observation,and survived with early disposal.Three cases appeared small blebs,with incision decompression,and other 4 cases were suffered from medical complications,the flaps healed up postponably.Conclusion The perioperative management should include accurate evaluation of general condition,sufficient preoperative preparation,appropriate choice of flap and operation procedure,careful observation,nursing and reasonable medication after operation,all of which are the key to diminishing the risks for the flap repairing of defect of skin and soft tissue on heel.