Flaps, grafts and drains

Question 1

Give 3 reasons why skin flaps fail

Answer 1

Arterial/venous occlusion
Tension (direct from flap or from haematoma/seroma)
Infection

Question 2

Artierial/venous occlusion cause skin grafts to fail. What can cause arterial/venous occlusions?

Answer 2

Thrombi
Torsion
Stretching

Question 3

How can skin flaps be assessed for success?

Answer 3

Colour
Temperature
Sensation 
Hair growth 
(Fluorosecein)

Question 4

How can partial necrosis of a skin flap be managed?

Answer 4

Ointments
Debridement followed by opened wound management with or without secondary closure
Another flap?

Question 5

How do free skin grafts survive?

Answer 5

Revascularisation from graft bed

Question 6

What are some factors that a free skin graft requires to be successful?

Answer 6

Suitable recipient bed
Good contact
No movement
No infection

Question 7

What is the purpose of surgical drains?

Answer 7

Remove excess fluid from wounds and to close dead space

Question 8

What are the 2 basic types of surgical drains?

Answer 8

Active drains (rely on negative pressure)
Passive drains (rely on gravity and capillary action)

Question 9

What is a major complication of drain placement? How can this be prevented?

Answer 9

Infection

Prepare site as for surgery, place aseptically, cover drain with a dressing (non-adherent, absorbent)

Question 10

Why should you not exit a drain along or through a suture line?

Answer 10

Promotes wound dehiscence

Question 11

When should drains be removed?

Answer 11

When a consistent, small volume of serosanguineous fluid is produced
(Drains incite an FB reaction - always some fluid present)

Question 12

If a drain is no longer producing fluid, is it ready to be removed?

Answer 12

No - shows drain blocked

Should always be some fluid as drain causes FB reaction