Bologna CH148 Grafts Flashcards
The first 48 h period following graft placement is the stage of plasmacitic imbibition
False - first 24h
IMBIBITION refers to fibrin glue attaching the graft to the recipient bed
True
Graft gains 75% in weight during imbibition
False , 40%
Revascularisation follows imbibition
True
During revascularisation , anastomoses begin to form within 48-72 hours
True
Relatively avascular tissue cannot be grafted
False, can so long as avascular area is small and surrounded by a rich vascular supply
Full circulation is restored to the graft after 10 days
False , within 4-7 days
Graft reinnervation and return of sensory nerve function may begin as early as 2-4 weeks after grafting, although patients do not usually regain full sensation for many months
True
Haematoma, seroma , infection and mechanical shear forces tend to affect STSGs more than FTSG
False , as FTSG have a greater volume to nourish and revitalise
Smoking is the most important factor decreasing vascular supply nourishing the undersurface of the graft
True
Causes of graft failure
Smoking, DM, protein deprivation, severe trace element or vitamin deficiencies Insufficient vascularity due to necrotic debris within recipient bed Haematoma Seroma Avascular wound bed Excessive graft tension Previous radiotherapy Infection Improper post op care
Most common infectious agents associated with graft failure include coagulase-positive staphylococci, B-haemolytic strep and pseudomonas spp.
True
Purse string reduces defect by 75%
False 50%
The ideal graft is moderately red when bolster is removed
False - pale or light pink . However, its colour may range from pink or red to darker blue or purple depending on the extent of revascularisation
A bluish tinge to the graft is a sign of graft failure
False, may be a sign of ecchymoses rather than graft failure.
A black graft signals necrosis
True
STSG exhibit significant post operative hypopigmentation but not hyperpigmentation
False , both. Darker skinned patients are particularly prone to graft hyperpigmentation
Graft (STSG) fragility and breakdown can occur in areas of trauma, particularly over areas with little underlying soft tissue support
T
Bullae can occur within graft sites, presumably related to decreased anchoring properties of BM zone
True
Composite grafts require rapid revascularisation to survive
True
Composite graft healing process goes through four stages:
- tissue blanches completely after graft placement
- 6hr - graft becomes pale pink , signifying anastomoses of graft vessels with those of recipient site
- 12-24h, graft appears dusky blue, reflecting venous congestion
- 3-7 days, should be pink indicating graft survival
Composite graft sites are usually allowed to heal by second intention with good aesthetic outcomes
True
If composite graft survives but cosmetic result is suboptimal, dermabrasion or laser resurfacing may be performed 6 wk to 6 mo post operatively to correct textural difference between the graft and the surrounding skin and to improve colour match between them
True
Free cartilage grafts may be used for nasal sidewall but not tip reconstruction
False
Nasal tip grafts provide proximal but not distal structural support
False
Post op complications following cartilage grafting are very common
False, rare
Post op tenderness, swelling and erythema may herald inflammatory chondritis or perichondritis
True
Later complications of cartilage graft may include graft resorption , displacement or deformation after placement, and extrusion
T
