4. Excessive granulation tissue/Skin grafts

Question 1

Equine wound healing

Answer 1

Limb wounds - slow healing
Distal limb wounds - excessive granulation tissue = fraud flesh
Limb wounds = increased motion, decreased vascularity

Question 2

Distal limb wounds

Answer 2

healing potential limited
No muscle, extra tissue
Constant movement, contamination
often only 2nd intention healing

Question 3

Proud flesh

Answer 3

Excessive granulation tissue - delays healing

Tx - resection and bandage, delayed secondary closure, skin grafts

Question 4

Why proud flesh

Answer 4

Protracted inflammatory phase
= excessive proliferation phase

fibroblasts maintain synthetic role
PMNs stay higher for longer
PMNs release pro-inflammatory phase

Question 5

Management of proud flesh

Answer 5

Surgical resection
Bandaging
Delayed secondary wound closure

Question 6

About skin grafts

Answer 6

Simple - performed in a standing horse

Requires granulation bed: healthy, flat, no hematoma, no fissures

Question 7

Indications for skin grafts

Answer 7

large wounds that won’t heal

Any open wound that can’t be sutured

Question 8

Skin graft classifications

Answer 8

Pedicle graft - remains connected to donor site

Free graft - completely separated from blood supply

Question 9

Free graft types

Answer 9

Full thickness - best cosmesis and hair growth

Split thickness

Question 10

Split thickness dermis amount

Answer 10

Dermis is inversely proportional to ability to survive

Dermis is directly proportional to durability and cosmesis

Question 11

Graft acceptance stages (4)

Answer 11

Adherence - fibrin
Serum imbibition - nourished by capillary action
Revascularization - 48hrs (neovascularization), 4-5d (revascularization)
Organization - epidermis thickens in first 2wks

Question 12

Free skin graphs

Answer 12

Island grafts: Pinch and punch

Sheet grafts: solid or meshed

Question 13

Pinch graft

Answer 13

tent skin, use #11 blade to cut.

Recipient pockets - #15 blade into granulation tissue

Question 14

Punch graft

Answer 14

Harvest under mane and ventrolateral abdomen - excise SQ fascia and fat
Recipeint holes - created first, start distally, one size smaller than biopsy
60-75%

Question 15

Island graft advantages and disadvantages

Answer 15

A: GA not needed, minimal equipment/expertise, complete failure rare
D: Poor cosmesis, little hair growth

Question 16

Sheet grafts solid vs mesh

Answer 16

mesh covers larger surface than graft itself

Confirms to irregular surface

Question 17

Full thickness

Answer 17

GA - resist trauma better than split thickness
best cosmetic appearance
Not as readily accepted

Question 18

Graft failure reasons

Answer 18

Hemorrhage
Motion
INFECTION

Question 19

Prep of recipient site

Answer 19

Most important for survival of free graft
Clean healthy granulation tissue flush with skin
Ticarcillin

Question 20

Graft aftercare

Answer 20

Cover with non-adherent dressing

Follow with routine bandage

Question 21

Conclusion of wounds

Answer 21

distal limb wounds can be devastating and expensive
Lack of soft tissue covering and presence of vital structures makes it challenging
Accurate dx and tx, aggressive debridement and immobilization