veoexrmpzt
Dołączył: 21 Lut 2011
Posty: 371
Przeczytał: 0 tematów
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Skąd: England
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 Wysłany: Nie 13:50, 27 Mar 2011 Temat postu: ghd piastra ucr guz nuyl epk |
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Large area of skin avulsion of early diagnosis and treatment of emergency
,[link widoczny dla zalogowanych], Enter the Ringer lactate solution, colloidal solution or blood products; concurrent traumatic brain injury were treated with mannitol dehydration, respiratory disorders to maintain airway patency or endotracheal intubation, a respirator or portable ventilator simple control of breathing,[link widoczny dla zalogowanych], with no obvious respiratory disorders nasal catheter oxygen; a pneumothorax or hemothorax with a chest when closed ● -} drainage; limbs, bleeding wound a tourniquet or pressure bandage to stop bleeding. Necessary imaging; blood pressure dips too low or when the intravenous injection of dopamine, ephedrine and other vasoactive drugs; cardiac arrest cardiopulmonary resuscitation immediately. Treatment process, except in special circumstances, full monitoring of ECG, blood pressure, respiration and pulse oxygen saturation (SpO2). For large area of pure physical treatment of skin avulsion injuries, the key issue is to determine the skin blood circulation and physical wounds of the skin coverage. Depending on the location, different levels and different areas of skin laceration, were replanted in situ flaps, free skin grafts, pedicle flap repair methods. Outside the exclusion of other concurrent organ injury, 59 cases of simple large area of skin avulsion injury patients, 51 flaps survived completely, two cases of a small number of flap necrosis, the other four cases flap in situ replantation of l / 3 necrosis , 2 flaps necrosis. Followed up for 6 to 12 months, by the almost normal appearance and function areas, 46 cases of lower extremity large area of skin avulsion in 19 patients taking anti-skin pedicle method to repair, 27 patients taking anti-skin method to take a simple repair. The results of pedicled skin treatment against taking in 19 cases, skin graft survival rate of 94.7% (18/19); simple skin treatment against taking 27 cases, skin graft survival rate was 88.9% (24/27). 3 Ts discussion is based on the body after traumatic circulatory, respiratory and central nervous system response to the digital form of quantitative assessment of injury severity as a simple method of treatment and research in trauma has played a positive role. For large area of skin laceration alone in patients affected by limb skin avulsion injury of the scope and extent of material with the injury, injury mechanism,[link widoczny dla zalogowanych], the contact area the size of material injury, violence, size and other factors. The performance of different forms, some expressed as a simple skin avulsion. Some of the performance of the body under the skin, subcutaneous tissue, together with its status was set along the long axis of the limb was avulsion of anterograde or retrograde. Some showed only scattered limb skin laceration wounds or bruises in the spots, body surface pale, cold, soft, and sensory loss, but the subcutaneous tissue and deep fascia strip between the occurrence of a wide range of stealth. In addition, some outside the avulsion is still associated with deep tissue, such as muscles, nerves, blood vessels and bone and joint injuries or associated with other major organ damage. Comparison of subcutaneous tissue of limbs loose and have some mobility. Therefore,[link widoczny dla zalogowanych], when the skin has been badly crushed limbs and tearing frustration when prone to skin avulsion injury. Limbs, large areas of skin avulsion in situ under different circumstances replanted flap and free skin grafts, pedicle flap of the treatment is effective. Large area on the lower limb skin laceration, according to degree of injury and was a complete avulsion of the skin or not, the blood supply is good or not, take the skin pedicle law against taking or not taking anti-skin pedicle method simply wound repair can achieve good results . In the examination and treatment must pay attention, because within the skin avulsion retrograde venous obstruction, blood stasis, in the press, the skin becomes purple from pale, easy mistake to think that a good part of the skin's blood circulation,[link widoczny dla zalogowanych], after debridement , only the broken skin on the body as a simple suture, postoperative will inevitably lead to widespread skin necrosis. 2 cases of post-skin graft is not more successful is this causes. Therefore, we must diagnose clearly. Treatment, such as limb large area of skin avulsion injuries, there are some parts after debridement of deep tissue exposure, such as the wrist tendons, nerves and blood vessels, can not accept post-free skin graft or skin graft will cause serious tendon adhesions of hand functional recovery of persons, should be used free skin graft and flap coverage of a combination of wounds, in the upper arm and forearm skin at the use of free skin graft, pedicled skin flap using wrist wound higher survival rate. In short, should be in accordance with the specific circumstances of a variety of effective treatment. 【
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