Skin flap with vascular peduncle

Skin flap is the process of removing an area of ​​skin on an uninjured body part (with similarities with the lost damaged skin) to implant to heal the damaged skin.
Types of skin flaps are usually taken:
Skin flaps in place: This is a skin flap in the adjacent area, the advantage is that the skin donor and recipient areas are nearly equal in skin color and thickness. Commonly used skin flaps are ATASOY skin flaps, MOBERG skin flaps, and finger peduncle flaps. Regional skin flap: The skin flap is taken not near the skin loss area, the skin donor area and the skin receiving area are not similar. Including skin flaps: cross-finger skin flap, kite skin flap, female tissue flap. Distal skin flaps: Skin flaps are taken from a distal area of ​​the body to cover larger areas of skin loss, possibly from the groin, chest, skin donor areas that are usually not suitable for the recipient.

2.1 Indications Indicated for surgery to transfer skin flaps with stalks for patients with skin loss lesions exposing finger bones tendons.
2.2 Contraindications Soft sores are still infected Nutritional disorders such as edema, many blisters Exposed bones but inflammation There are systemic diseases such as diabetes, cardiovascular ... need to be treated stably Pre-determined 2.3 Patient Preparation: Patient psychology, complete medical records, administrative procedures and tests. Performer: Orthopedic trauma surgeon and two assistants Means and equipment: General trauma surgery kit Estimated surgery time: 90 - 120 minutes Check that the records are correct and complete according to request yet? Check that the patient is correct and has been properly prepared?

2.4 Perform technique Endotracheal or spinal anaesthesia.
Skin flap removal technique:
Mark the location for taking skin flaps Draw the skin island and the axis of the skin flap, the flap stalk is a fatty tissue containing nerves and blood vessels The length of the skin flap is measured from the point of rotation to the farthest edge of the defect Length of skin flap stalk: Measured from the point of rotation to the nearest edge of the defect. The patient's position is supine, 1/3 G thigh (or not). Stage 1: Treat the lesion
Cut the edge of the lesion, cut the necrotic tissue from shallow to deep to ensure no necrotic tissue. Irrigation several times with hydrogen peroxide, salt water, Betadine. The surface of the bone is exposed if it is inflamed. Careful hemostasis of the lesion. Check the designed skin flap to see if it is suitable for the lesion that has just been removed. Apply moist gauze to the affected area to switch to then peel off the skin flap. Stage 2: Peel off the skin flap
Dissection to find veins and nerves Incision of the skin around the skin island until the end of the fascia layer, leaving the part connected to the skin flap stem. Stitches to fix the fascia with the skin around the island so as not to dissect between them, causing damage to the blood vessels from the fascia to feed the skin. Skin flap pedicle dissection Raised flap from top to bottom with a fascia and flap peduncle with only subcutaneous fat and fascia. Remove the garo to check the perfusion status of the skin flap, stop bleeding carefully, select the angle of skin flap rotation so as not to twist the skin flap stem.

Make a tunnel or make an incision in the skin to bring the flap to cover the flaw. Stitch the skin flap to fix the defect, put drainage under the flap (or not). Sew 2 edges of thick skin where the skin flap is removed. Sew close up the place for the skin flap, thin skin patch or Wolf-Krause skin graft where the skin flap is taken. The bandage is gently pressed, leaving a part of the skin flap open to closely monitor the perfusion status of the skin flap, promptly detecting the pinching of the skin flap for treatment. 2.5 Postoperative antibiotic treatment for 5-7 days. Anti-edema, anticoagulant. Thin skin grafting on flap if flap is good (usually after 5-7 days).
Withdraw drainage after 48 hours, change dressings daily, detect bleeding and infection complications.
Transfer of skin flap with vascular pedicle is a skin flap that has many advantages in covering loss of skin in exposed lobe area, high success rate, skin flap has good feeling, fast healing time and helps patients Quick return to life, good coverage of the transverse or beveled area of ​​the back and heart.
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