Objective To investigate the application and effect of the crossbridge vascular anastomosis free flap transplantation for tissue defects of extremities. Methods From May 1982 to November 2005, 110 cases of tissue defects of extremities were treated with cross-bridgevascular anastomosis free tissue transplantation. Of 110 patitents, 80 were male and 30 were female with a median age of 30 years(5 to 54 years). Tissue defects were caused by traffic accidents (59 cases), machine injuries (32 cases) and mangled injuries (19 cases). The locations were the forearms in 2 cases and the legs in 108 cases. And 69 cases had simple soft tissue defects, 6 cases had simple bone defects, and 35 cases had complicated defects. The length of bone defectranged from 5 cm to 19 cm and the area of soft tissue defect ranged from 6 cm×10 cm to 15 cm×35 cm. The graft tissue included latissimus dorsi musculocutaneous flap, vastus anterolateral flap,cutaneous fibula flap, osseous fibula flap, and cutaneous iliac flap. The cross-bridge of the two lower extremities wasperformed in 106 cases, the cross-bridge of the two upper extremities in 2 cass, and the crossbridge of the upper-lower extremities in 2 cases. The compoite tissue transplantation was used if the graft tissues were two or more. The wounds of donor site was directly sutured in 67 cases, and partly sutured with skingrafting in 43 cases. Results Vascular crisis occurred in 9 cases. Vascular crisis was relieved in 5 cases and grafting tissues was survival after exploring the vessel; 4 cases failed. The graft tissue was survival in 101 cases, and the survivalrate was 96.4%. The follow-up time was 4 months to 22 years with an average of 6.3 years. Graft bone healed and mean healing time was 4 months. The flap appearance was satisfactory and extremity function was restored to normal. One case became necrosis in the edge of the flap and cured by debridement, dressing and skingrafting, the other got primary healing at 2-3 weeks after operation. Conclusion The application of the cross-bridge vascular anastomosis free tissue transplantation for tissue defects of extremities is an effective method, when extremities have no vessel anastomosed.
Objective To construct a nursing sensitive index system for limb blood circulation monitoring, to guide clinical nursing practice, and provide a scientific basis for the evaluation and management of limb blood circulation monitoring nursing quality. Methods The Chinese and English databases such as China National Knowledge Infrastructure, Wanfang, VIP, PubMed, and Web of Science were searched from the establishment of the database to April 1st, 2024. Using the structure-process-outcome three-dimensional quality system model as the theoretical basis, and through semi-structured interviews, an expert letter consultation questionnaire containing 3 first-level indicators, 9 second-level indicators and 30 third-level indicators was developed. The final nursing sensitive index system of limb blood circulation monitoring were determined through two rounds of expert consultation. Results A total of 25 experts participated in the questionnaire survey. The positive coefficients of the two rounds of expert consultation were 96% (24/25) and 100% (24/24), respectively, the expert authority coefficient was 0.906. The final nursing sensitive index system included 3 first-level indicators, 6 second-level indicators and 21 third-level indicators. All the indicators were closely related to limb blood circulation monitoring, and the quality of specialized nursing work of limb blood circulation monitoring was comprehensively improved from the three dimensions of structural indicators, process indicators, and outcome indicators. Conclusion The nursing sensitive index system of limb blood circulation monitoring has strong specialty, it not only clarifies the specific content of limb blood circulation monitoring and nursing work, but also systematically constructs the requirements and standards of the quality management level of blood circulation monitoring, which is scientific and practical.