Flaps, grafts and scar management Flashcards
1
Q
Flaps
A
- a unit of vascularized tissue that is transferred from a part of the body to another
- may contain single tissue or combination
- critical to have blood supply to survive
- monitor healing closely-vital signs, color, temperature, capillary refill time
2
Q
Skin grafts
A
- composed of epidermis and some dermis
- does not need a blood supply
- donor site: harrvested from healthy skin
3
Q
Classifications of skin grafts
A
- full thickness: entire dermis and epidermis
- split thickness: superficial partial thickness depth (may be thin, medium or thick) can be meshed
4
Q
Origins of skin grafts
A
- autograft: donor and recipient are same individual
- allograft: donor and recipient different individuals (cadavers) usually temporary
- xenograft: graft btw 2 different species )pig to human)
5
Q
Skin graft management
A
- goal to protect graft from shearing or displacement, minimize hematoma formation, decrease possibel infection
- soaked gauze to keep moist
- splint to protect site
- compression wrap to prevent hematoma
- once graft adhered: ointment dressing gauze
6
Q
donor site management
A
- Goal: to maintain moist tissue bed to encourage healing, decrease pain and control infecion
- common dressings
- petroleum gauze
- transparent gauze
- hydrocolloid dressings
- alginate for high exudate
- once healed: moisturizers
- keep out oof sun or use at least SPF 30 for 2-3 years
7
Q
Scars
A
- scarring is related to: age, ethnic origin, severity/depth and location of burn
- scar formation begins with proliferation and stimulation of fibroblasts during inflammation
- collagen deposts strengthens wound site and collagen degradation remodels the wound
- predictors of scars: deep wound, high pigementation, skin tension, younger pts
8
Q
Scar management
A
- burn scars require 6 months to 2 years to mature
- formation of scar may lead to cosmetic and funcional complications
- during remodeling phase: gental cleansin, moisture, gentle massage
- complications: hypertrophic keloid
9
Q
Scar types (complications)
A
- hypertrophic: too much scar tissue
- keloid: excess scr tissue expands beyond wound barriers
10
Q
What is the vancouver scar scale
A
- describes the quality of scar tissue afterr burn, monitors success of scar modeling intervention
- looks at vasculatiry, pliability, pigmentation, height
- score ranges from 0-14
11
Q
Scar management treatment
A
- positioning
- proper wound care
- AROM/PROM (if they cannot move through full ROM)
- patient education
- stretching
12
Q
scar management: specific strategies
A
- pressure therapy
- modalities
- conformers/insert
- massage
- splinting/casting: prevent contractures
- silicone gel sheets
- avoid sun exposure to healing scars
13
Q
scar mobilization
A
- help remodel scar tissue quality and appearance
- compression wrraps/garments: used prophylactically to prevent excess scarring (self adherent wrap, short stretch bandage, tubular bandage)
- silicon sheets: help reduce or pvent scarring of healed, intact, burned skin. secured with gauze or combo witth compression
- massage: loosen adhesions, combine witht stretching scarce evidence
14
Q
Silicon sheets
-
A
- used to soften scare, enahnce scar flexibility an dextensibility, improve appearrance, reduce itching,m redness and inflammation
- does not require pressure to be effective adn early application is key to produce effective outcomes
- theory of action: hydration, decrease osygen tension, hypoxia stimulates angiogensis and tissue growth and increased temperatures helps breakdown collagen bundles
15
Q
Compression garments
A
- pressure required to minimize scars is controversial
- 24-28 mmHg is accpeted average
- difficult to determine how much pressure is truly applied - lose 50% of compression in first month of wear
- monitor closely esp in children: wounds, blisters, skeletal dental disturbances
16
Q
Marjolin’s ulcers
A
- malignant degeneration arising from pre-exisiting scar tissue
- mostly squamous cell tumors
- treatment: wide local incision w/ skin graft
- occurs over a previous scar
