Purpose The reconstruction of medium-sized soft tissue defects of the fingertip remains a challenge for hand surgeons. The aim of this study was to compare the outcomes of modified triangular neurovascular unilateral advancement flap and digital artery dorsal perforator flap in the treatment of this injury. Methods From May 2018 to May 2022, 70 patients with medium-sized volar soft tissue defects were enrolled. The patients were divided into two groups based on the flap type: modified triangular neurovascular unilateral advancement flap (Group A) and digital artery dorsal perforator flap (Group B). The debridement times, defect size, operation time, and flap survival rate were recorded. At follow-up, hand function, aesthetics, and complications were evaluated. Function was evaluated using the TAM score. The aesthetics of the reconstructed and donor sites were assessed using the vancouver scar scale (VSS). The static two-point discrimination of the finger pulp served as a measure of tactile agnosia. Results A total of 10 patients were lost to follow-up for various reasons, resulting in 30 cases remaining in each group. The general information of the two groups showed no significant differences in age, sex, injury side, cause of injury, time from injury to surgery, and operation time ( P > 0.05). Additionally, the debridement times and size of the defect were similar between the groups ( P > 0.05). However, the operation time was significantly shorter in Group A compared to Group B ( P = 0.001). With regard to complications, there was no significant difference between them. At one-month follow-up, TAM scores indicated that Group B performed significantly better than Group A. However, at the final follow-up period, there was no significant difference in TAM scores between the two groups. When considering the VSS, significant differences were observed between the two groups in both the reconstructed site and donor site. Conclusion Both flaps can effectively repair medium-sized fingertip defects. Furthermore, the modified triangular neurovascular unilateral advancement flap offers anatomical reconstruction possibilities, ensuring satisfactory sensation and cosmetic contour.

Objective:To summarize the clinical application value of color Doppler ultrasound (CDU) in the nursing observation of flap vascular circulation after free flap transplantation.Methods:From September 2018 to November 2020, 18 patients with skin defect of limbs treated by free flap transplantation in the Second Affiliated Hospital of Wenzhou Medical University were monitored by skin color, skin temperature, skin tension, capillary reaction time and CDU. When the vascular circulation disorder was found, the patients should be treated with volume expansion, rehydration, local massage of the flap, anticoagulation and microcirculation improvement. Positive drainage under the flap to prevent infection, combined with hyperbaric oxygen treatment, accurate and timely exploration of vascular crisis to avoid flap necrosis.Results:Postoperatively, CDU monitoring found that 2 cases had regional vascular circulation disorder, 1 case had complete embolization of the main vessels and perforators in the flap, the flap was thinned and changed to full thickness skin grafting, the deep tissue exposed area was healed by dressing change, and 1 case had incomplete embolization of the flap′s reflowing vein. After operation, the venous crisis was relieved and the flap survived completely.Conclusions:Comprehensive observation is needed after free flap transplantation. Combined with four routine vascular circulation indexes, CDU monitoring of flap blood flow can provide more objective, accurate and detailed basis for vascular circulation status, and can accurately find the vascular circulation disorder after free flap transplantation in early stage, and understand the vascular flow status of the flap, so as to effectively avoid the continuous progress of vascular crisis, to avoid flap necrosis and improve the survival rate of flap.

目的 探讨如何在幼儿上肢矫形手术中规范化使用气囊止血带.方法 经过纳入和排除标准的筛选,最终选择2019年1—12月在我院行上肢矫形的60例患儿,分为三组,对照组、研究组1和研究组2分别使用上臂5 cm、上臂7 cm和前臂5 cm气囊止血带.记录止血压力、止血效果、止血带压迫以及是否对手术造成干扰,并进行组间对比.记录各组术中止血效果不佳时的处理情况.记录并对比三组收缩压以及术中变化的情况,评估使用肢体闭塞压力(LOP)作为止血带压力的总体有效率.结果 三组LOP和实际使用的压力:研究组2

踝关节不稳(CLAI)是临床常见的一种疾病,主要是指踝关节周围韧带受损后造成的踝关节不稳定,使踝关节出现频繁扭伤[1].研究发现,其与韧带完整性、平衡能力、神经肌肉控制以及姿势控制等密切相关,手术治疗方式主要包括解剖手术、解剖重建以及非解剖重建[2].研究发现[3],对于行手术治疗的患者在术后如不对其进行有效护理,患者会出现一系列的并发症.延续性护理是一种通过电话回访、健康教育设立专门的护理小组等为主体的护理方式,具有简便、经济及高效等的优点[4].本研究拟探讨延续康复护理在踝关节不稳术后中的应用效果,报道如下.

为推广及探讨个案管理在护理工作中的应用,本文对个案管理的概念、实践模式、国内外实施现状进行阐述,讨论对行经皮冠状动脉介入术(PCI)患者实施个案管理的必要性以及个案管理应用于PCI患者需注意的几个关键问题,从而为医疗卫生系统发展新的护理模式提供借鉴.

目的 探讨三级质控护理模式在手术室护理中的应用价值.方法 2018年开始我科实行三级质控护理管理,比较2018年(三级质控护理模式)和2017年(“护士长责任制”护理管理模式)手术室不良事件发生情况及护理人员“三基三严”理论、消毒隔离质量、急救物(药)品管理、护理文书书写质量考核成绩.结果 2018年手术室不良事件发生率显著低于2017年(p＜0.05);护理人员各项考核成绩显著高于2017年(p＜0.05).结论 三级质控护理模式能够降低手术室不良事件的发生率,提高护理人员业务水平,提高护理质量,值得在临床中推广应用.

报道10例游离皮瓣发生血管危象经手术探查后血液循环的观察与护理方法 ,包括掌握观察原则、了解皮瓣动静脉危象探查术后血液循环的特点和观察方法 .本组7例患者的皮瓣出现静脉危象,3例患者的皮瓣出现动脉危象,及时手术处理后恢复正常血液循环.本文归纳了血管危象术后皮瓣的常规护理方法 ,同时总结了探查术后皮瓣的血液循环,即通过皮肤温度、皮肤颜色、皮肤张力、毛细血管回流反应进行判断,也可应用超声多普勒血流仪、皮瓣远端小切口观察血流进行判断.

目的 探讨快速康复护理模式在骨科患者围手术期中的应用效果.方法 选择2016年4月-2017年10月我院收治的80例创伤性骨折患者作为研究对象,用随机数字表法将患者分为两组,各40例.观察组患者接受快速康复外科护理,对照组患者接受骨科常规围手术期护理.比较两组患者的总体满意度、护理依从性、常见并发症发生情况.结果 观察组患者对护理的总体满意度、依从性高于对照组,常见并发症发生率低于对照组,差异有统计学意义(P＜0.05).结论 快速康复护理能够提高骨科手术患者护理依从性、降低并发症发生率、提高患者满意度,值得临床推广.

目的:了解手术患者的隐私保护需求,进一步探究手术患者隐私保护的对策.方法:以2015年6月～2016年6月温州医科大学附属第二医院手术治疗的300例患者为研究对象,自行设计问卷进行手术患者隐私保护的分析调查.结果:女性、年龄小于20岁、具有大学文化程度以上、未婚、具有宗教信仰的手术患者对隐私保护需求较高.在5个隐私保护项目中,隐私部位、病史病情保护分值比例最高,分别为37.9％、28.5％.结论:加强手术患者隐私保护是当前手术患者的强烈需求,院方管理层要通过建立健全各项管理制度、加强职业操守培训,加强法律法规教育,充分尊重患者的知情同意权措施,从而实现对患者的隐私保护.

目的:比较股静脉垂直穿刺采血法与股静脉斜刺采血法在小儿先天性髋关节疾病中的应用效果。方法:选择小儿先天性髋关节疾病患儿226例,采用随机分类法分成两组(观察组和对照组),其中观察组患儿(113例)采用股静脉斜刺采血法,对照组(113例)患儿采用股静脉垂直穿刺采血法,比较并记录一次采血成功率、新手成功率、穿刺部位血肿发生率及肥胖儿一次成功率。结果:股静脉斜刺采血法成功率为90.3%,股静脉垂直穿刺采血法成功率为76.1%。结论:股静脉斜刺采血法更适合在小儿先天性髋关节疾病中应用。

寒颤是指患者出现不随意的肌肉收缩,一般表现为外周血管收缩和中心体温下降,往往会造成机体耗氧量增加[1].经尿道前列腺电切术(transurethral resection of the prostate,TURP)是治疗前列腺增生的手术方式,具有疗效好、创伤小、恢复快、禁忌证少等优点,常用于高龄前列腺增生患者.

<正>胸腰椎爆裂性骨折指前、中柱在轴向压缩载荷作用下发生的损伤,是临床上常见的脊柱损伤[1]。随着现代建筑业及交通运输业的迅猛发展,高能量创伤日趋增多,严重的胸腰椎爆裂性骨折也日益增多。其常因巨大的暴力引起脊柱的

<正>神经刺激器引导腰丛-坐骨神经阻滞技术能精确定位神经,麻醉效果确切,能提供较长时间的术后镇痛,而且该技术对血流动力学和全身的影响较全麻或

胃癌是我国常见的恶性肿瘤之一,占消化道肿瘤的首位,手术切除是其主要治疗手段.新型超声刀近年来广泛应用于腹腔镜手术中,其通过高频的声波振荡产生机械能,使组织凝固变性,从而达到切割止血的目的。

Objective To discuss the effect of holistic nursing for the patients in perioperative period.Method After writing informed consents,500 patients were equally randomized into two groups receiving integrated nursing and traditional nursing separately.An comparison of peri-operative satisfaction level was conducted between the two groups and the cardiac rate and blood pressure were recorded 2 hours before operation and 5 minutes after entering operation room.Results The satisfaction level of the integrated nursing group (98%) was significantly higher that that of the traditional nursing group; the dissatisfaction level of the integrated nursing group was significantly lower that that of the traditional nursing group(P0.05).The cardiac rate and blood pressure recorded 5 minutes after entering operation room were significantly higher than those recorded 2 hours before operation (P0.01) in the traditional nursing group and were not significantly different in the integrated nursing group (P0.05).Conclusion The patients recieved integrated nursing had marked good mental state, eliminated the foreignness and emotional tension,reduced the stress response of the patients,avoided unstable life signs caused by mental factors,strengthened the trust on doctors and nurses.

总结新生儿腹腔镜手术的术中配合经验和术前、术后的护理要点。根据腹腔镜手术的特点和患儿的病情,做好术前访视,仔细评估患儿病情,发现异常及时报告医生,做好急诊手术的准备,缓解患儿家属紧张情绪,指导其正确禁食、禁水;术中注意保温、补液的护理,严密监测腹腔镜的各项参数;术毕采取措施预防反流误吸及气道梗阻。本组46例患儿手术均获成功,无中转开腹手术者,无并发症发生,均痊愈出院。

随着内窥镜技术的广泛应用和不断进步,传统的开腹检查和手术越来越多地被内窥镜下检查和手术所取代,宫、腹腔镜因手术损伤小、出血少和患者痛苦小,目前应用宫、腹腔镜技术诊断、治疗妇科疾病已越来越普遍[1].我院为30例妇科患者进行了宫、腹腔镜联合手术,现将护理体会介绍如下。

小儿四肢畸形无论是多指(趾)、并指(趾)、马蹄内翻足等先天性畸形还是因烧伤、创伤等后天性原因造成的畸形,多需要行外科矫形术使达到矫正畸形、恢复功能,促进心理健康和回归社会的目的.

采用自行设计问卷调查温州地区226名手术室护士利器损伤的状况,主要包括易致利器损伤的器械种类,损伤后的处理措施,获得防护知识途径及工作年限与利器损伤次数的关系,认为手术室是具有独特接触血液和锐器损伤的高发科,重点做好手术室护理工作中的职业防护尤为重要。