Excessive Granualtion Tissue and Skin Grafting Flashcards
Which wound location heals faster: limb or body?
- Body! ** contracts and heals 1mm/day**
- Limb heals slow (0.2mm/day) –> has increased motion and decreased vascularity
What is proud flesh?
Excessive granulation tissue on the distal limb
What types of wound closures can you use on distal limb wounds?
- Primary and secondary best for function and cosmetics, but 2nd intention can still work
What causes proud flesh and how do you treat it
- Causes: topicals applied to horse by owner –> results in lesser inflammatory phase and greater proliferative phase (lots of fibroblasts and PMNs)
- Treat: resect, bandage, delayed secondary closure, skin grafts
Why is excessive granulation tissue a bad thing?
- it delays healing
- *only seen in horses and humans**
- *granulation tissue itself is not always a bad thing**
How do you manage excessive granulation tissue?
- surgically resect (best way), bandage, delayed second wound closure
When is a skin graft indicated
- Large wounds that won’t heal any other way
- Unsuturable open wounds
What are the classifications of grafts?
- Pedicle graft –> remains connected to donor site
- Free graft –> completely separated from blood supply
- Full thickness –> consists of epidermis and full dermis best for cosmetics
- Split thickness –> epidermis and partial dermis
How do you know the graft has been accepted?
- The graft adheres, serum imbibition, revascularization ( 4-5 days), organization (epidermis thickens)
What are some examples of free skin grafts?
- Island grafts (punch, tunnel, pinch/ seed), sheet graft, full thickness, split thickness
What are some advantages of punch and pinch grafts? Disadvantages?
- Advantages: no anesthesia or fancy equipment, not technically difficult, failure low
- Disadvantages: poor cosmetics and little hair growths
Where can you collect punch graft?
- Mane or ventrolateral abdomen
- *collect SQ fascia and fat**
- -> create recipient site by making smaller holes
How do you make a pinch graft?
- Pinch skin, remove with # 11 blade, stab blade into granulation tissue, insert graft into pocket
How can graft fails?
- Hemorrhage
- Motion
- Infection –> most common ( B-hemolytic strep and Pseudomonas)
What is the most important detail for survival of the free graft?
- Prep of the recipient site?
