Bologna CH148 Grafts

Question 1

The first 48 h period following graft placement is the stage of plasmacitic imbibition

Answer 1

False - first 24h

Question 2

IMBIBITION refers to fibrin glue attaching the graft to the recipient bed

Answer 2

True

Question 3

Graft gains 75% in weight during imbibition

Answer 3

False , 40%

Question 4

Revascularisation follows imbibition

Answer 4

True

Question 5

During revascularisation , anastomoses begin to form within 48-72 hours

Answer 5

True

Question 6

Relatively avascular tissue cannot be grafted

Answer 6

False, can so long as avascular area is small and surrounded by a rich vascular supply

Question 7

Full circulation is restored to the graft after 10 days

Answer 7

False , within 4-7 days

Question 8

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

Answer 8

True

Question 9

Haematoma, seroma , infection and mechanical shear forces tend to affect STSGs more than FTSG

Answer 9

False , as FTSG have a greater volume to nourish and revitalise

Question 10

Smoking is the most important factor decreasing vascular supply nourishing the undersurface of the graft

Answer 10

True

Question 11

Causes of graft failure

Answer 11

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

Question 12

Most common infectious agents associated with graft failure include coagulase-positive staphylococci, B-haemolytic strep and pseudomonas spp.

Answer 12

True

Question 13

Purse string reduces defect by 75%

Answer 13

False 50%

Question 14

The ideal graft is moderately red when bolster is removed

Answer 14

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

Question 15

A bluish tinge to the graft is a sign of graft failure

Answer 15

False, may be a sign of ecchymoses rather than graft failure.

Question 16

A black graft signals necrosis

Answer 16

True

Question 17

STSG exhibit significant post operative hypopigmentation but not hyperpigmentation

Answer 17

False , both. Darker skinned patients are particularly prone to graft hyperpigmentation

Question 18

Graft (STSG) fragility and breakdown can occur in areas of trauma, particularly over areas with little underlying soft tissue support

Answer 18

T

Question 19

Bullae can occur within graft sites, presumably related to decreased anchoring properties of BM zone

Answer 19

True

Question 20

Composite grafts require rapid revascularisation to survive

Answer 20

True

Question 21

Composite graft healing process goes through four stages:

Answer 21

• 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

Question 22

Composite graft sites are usually allowed to heal by second intention with good aesthetic outcomes

Answer 22

True

Question 23

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

Answer 23

True

Question 24

Free cartilage grafts may be used for nasal sidewall but not tip reconstruction

Answer 24

False

Question 25

Nasal tip grafts provide proximal but not distal structural support

Answer 25

False

Question 26

Post op complications following cartilage grafting are very common

Answer 26

False, rare

Question 27

Post op tenderness, swelling and erythema may herald inflammatory chondritis or perichondritis

Answer 27

True

Question 28

Later complications of cartilage graft may include graft resorption , displacement or deformation after placement, and extrusion

Answer 28

T