The Postoperative Observation On Two Types Of Abdominal Skin Flap To Repair The Hand Skin Of Degloving Injury

Objective: The hand skin of degloving injury in the clinical hand injuryis a common kind of trauma, the injured is often injured by the actions of withthe structure of a roller machine, the machine under the action of extrusionand the pull of the involuntary, produce hand skin, subcutaneous tissue, bloodvessels, nerves and set off together. Although there are a variety of methodsclinically repairing such damage, but curative effect is not exact, still is adifficult problem in. This study explore the improved abdominal ultra-thinbags flap with pedicle iliac groin skin flap to repair hand skin to take off theset of large-area injury effect of clinical application, and to guide clinicalopponents of the treatment for hand skin of degloving injury.Methods: Between January2011and September2012in our hospitalpatients with surgical treatment of finger injury of hand skin30cases,18cases of men, women,12patients, aged14-52, are associated with differentlevels of multiple fingers and the palm of your hand and hand back the skin totake off the set. Were randomly divided into experimental group (groupimproved abdominal ultra-thin bags flap)15cases and the control group(group pedicle iliac groin flap)15cases.Two groups of patients from the agestructure, sex structure with no statistically significant difference wereobserved in the degree of injury (P>0.05).Main comparative observation ofswelling in the skin flap after operation, infection, blood supply (test) capillaryfilling time, appearance, feeling nerve functional recovery, hand movementfunction recovery (activity of the proximal interphalangeal joint andmetacarpophalangeal joint) from treatment, patients’ subjective satisfaction,satisfaction, and the total effective rate difference.Two surgical preparation: patients take the hypothesis, limb outreach90degrees, after anesthesia satisfaction, standby tourniquet (with active bleeding limb blood after air displacement can advance to250MMHG), wound withwater and soap water, hydrogen peroxide solution of hydrogen peroxide (3%),normal saline (0.9%nacl) and new clean son out or benzalkonium chloride(benzalkonium bromide) amine solution after flushing, iodine and alcoholdisinfection to the central upper limb arm, avoid wound and drapes to theelbow. With new jie er die or distilled water diluted benzalkonium chloridesolution immersion wound for3minutes, saline rinse after thoroughdebridement, removal of necrosis and severe pollution of the skin,subcutaneous tissue and muscle tissue, after full relax tourniquet to stop thebleeding.Experiment group (group improved abdominal ultra-thin bags flap): afterthorough debridement, removal of off set refers to the body of the details thatcan be appropriately reserve base, residual soft packages are available, andstraighten out the needle was refers with fixed in place, the bleeding again,repair the torn tendons, the size of "yu ji", joint capsule and other tissuedamage, conditional case microscopic repair injury refers to the nerve, palmdorsal skin defect size measurement. Let hand injury in patients withabdominal put relatively comfortable position, abdominal design according tothe size of the hand finger defect skin into the improved bag shape can holdhand wound ultrathin skin flap, make "L" type of incision along the designlines, the first surface of the skin incision, follow the "L" type incision throughto the superficial fascia, skin flap. Attention fully hemostatic available electricknife surgery, blood coagulation. With scissors or spring scissors began fromthe flap edge trim to tiffany, a "ladder" or "slope" repairing the thin skin flapto keep fat thickness dermal vascular network hierarchy that is about2-3mm,will hurt the hand palm, the back of hand and finger under the flap embedded,proximal suture basal and on both sides of the flange, form the "pocket" holdhand, placed under the flap bag according to the circumstance of woundrubber drainage article number, when it is necessary to make joint negativepressure aspirator drainage of drainage pipe. Week bandaged wound and fixedthe limb. Postoperative anti-inflammatory, conventional treatment and other processing. In3-4days can charge patients postoperative wound hand exerciseappropriate activities within the abdominal wall, avoid joint stiffness.Postoperative3-4go flap pedicle broken, granulation tissue covering thewound, the remaining viable transferred flap repair and thighs get free skingraft cotton-covered pressurized. Abdominal wound dressing suture, theremaining free skin grafting wound is feasible. Interval8-12weeks installmentline points to surgery.Control group (group pedicle iliac groin flap): after debridementcompletely, will damage the main organization contains a vitality of nerves,tendons, etc., the conditional to repair one by one, with the thumb off set ofthe random skin flap or free hallux nail flap repair, more than2-5refers to becut to the bone after suture and refers to. After thorough hemostasis, accordingto the size of hand skin defect after debridement, abdominal design "racket"pedicle iliac groin flap, can be appropriately enlarge1-2cm. With obliqueinguinal femoral pulse place outside the top flap axis, base is located in thefemoral artery and iliac inguinal ligament intersection, cut the flap on theflange and the flange on both sides confirmed that the flap contains spin iliacshallow shallow blood vessels, blood vessels or abdominal wall free distal flapin the superficial fascia, proximal in shallow surface free of abdominalexternal oblique tendon membrane, of about4-5cm wide. Flap distal1/2-two-thirds of most of the fat layer to cut and keep dermal vascular network,the flap has n. The skin flip flap pedicle stitched into a hose, abdominalwounds can be directly suture, suture the skin tension when big cloth towelclamp or patellar clamp assist complete. Postoperative weeks wound and fixedlimb injury, postoperative3-4weeks off. Points refers to as the experimentalgroup.Results:Two groups of patients with basic flaps all survived.Experimental group (improved abdominal ultra-thin bags flap group),15casesflaps survived well, two groups of flap blood capillary filling time teststatistical analysis results in the repair of postoperative1,7,21days, andbroken, but there was no difference in the postoperative1day (P>0.05), but in broken, is there a difference test7,30days postoperatively (P <0.05), theexperimental group is better than the control group. Patients after l yearfollow-up, improved abdominal ultra-thin bags flap texture, appearance isgood, don’t need to thin, good joint function recovery, bare nerve and ultrathinskin flap is easy to contact, flap protective feeling can recover earlier. At thesame time is not easy to happen late contracture. Two groups of patients withpostoperative hand feeling nerve functional recovery test by the statisticalanalysis is1month after surgery (P>0.05) difference, but on June,12monthsafter surgery tests have difference (P <0.05), the experimental group is betterthan the control group. Postoperative wound hand motion range, according tothe statistical analysis of test results for two groups in postoperative1monthproximal interphalangeal joints, the result is no difference (P>0.05),1month,6months,12months after surgery and proximal interphalangeal joints,metacarpophalangeal joint from motion has the difference (P <0.05), theexperimental group is better than the control group. In addition, in patientswith subjective satisfaction, satisfaction survey, and the total effectiveevaluations are also improved abdominal ultra-thin bags flap group have anadvantage.Conclusion: The improved abdominal ultra-thin bags flap is easy todesign, don’t need to dissect blood vessels, operation is simple, safe, and easyto basic-level hospitals. This flap has the double pedicle division rich bloodsupply, high survival rate of skin flap, strong ability to fight infection.Ultrathin skin flap, good texture, elastic, no thin, easily accepted by patients,with dermal vascular network organization is easy to contact with the woundhand wounds exposed nerve, nerve cells proliferation, feeling protective of theflap could be early recovery. In addition, the improvement of ultra-thin bagsflap the abdomen may be effective in retaining refers to the length of the body,basal experimental part of the hand can keep to small, the hand activity,strength, and functional recovery of patients has important significance. Therefore improved abdominal thin flap can be used as hand bag off set oflarge-area wound repair is a better method of choice.