封闭式负压引流联合腓肠神经营养血管皮瓣修复足踝软组织缺损的标准护理干预

摘要

Objective To explore the early nursing intervention on the application of vacuum sealing drainage (VSD) technology combined with sural neurovascular flap transplantation for repairing soft tissue defect of the ankle.Methods Thirty-two cases of traumatic ankle soft tissue defect patients were collected,using VSD technology combined with sural neurovascular fascial flap to repair the defect.According to the situation of the flap transplantation,the step-by-step,comprehensive and standard nursing interventions were formulated,including comprehensive condition assessment,VSD negative pressure drainage nursing,perioperative psychological nursing,health education,rehabilitation directions and monitoring of postoperative blood flow and vascular crisis,and post-discharge functional nursing intervention.With the combination of normative nursing intervention,assessment was made of postoperative flap vascular crisis rate and function recovery of ankle joint.Results All flaps survived,and the area and donor site were healed in the first stage.All the 32 patients were followed up for 1 to 13 months,with an average of 10.5 months.The skin flap had good appearance and texture,and the two-point discrimination was 6 to 10 mm.The ankle joint function was good after operation,and no skin damage was found in the weight bearing area.Conclusions The application of VSD technology combined with sural neurovascular flap transplantation for repairing soft tissue defect of the ankle,together with the standard early nursing intervention mode throughout the whole process of treatment,can effectively avoid vascular crises and guide rehabilitation exercise to restore the long-dated function of ankle joint.%目的 探讨早期护理干预对应用封闭式负压引流(VSD)技术联合腓肠神经营养血管皮瓣带蒂转移修复足踝部软组织缺损的效果.方法 收治的32例外伤性足踝部软组织缺损患者,均采用VSD技术联合带腓肠神经营养血管筋膜蒂逆行皮瓣移植修复,根据皮瓣移植情况予以量化制定循序渐进、系统的、全面的标准化护理干预,包括全面病情评估、VSD负压引流术护理、围手术期心理护理、健康教育与康复指导和术后皮瓣血运及血管危象的监测,以及院外延续功能护理干预.以结合规范护理干预模式,评估术后皮瓣血管危象发生率及踝关节功能恢复情况.结果 术后皮瓣全部成活,受区及供区切口均Ⅰ期愈合.32例患者均获随访,随访时间1 ～13个月,平均10.5个月.皮瓣外形良好,质地耐磨;皮瓣两点辨别觉为6～10 mm.术后行走踝关节功能良好,负重区无皮肤破损.结论 应用VSD技术联合腓肠神经营养血管皮瓣移植转位修复足踝部软组织缺损,予以标准、规范的早期护理干预模式,贯穿于整个治疗护理全过程,可有效避免血管危象的发生,指导配合康复锻炼,以利于踝关节远期功能恢复.