Flaps, Skin grafts, tendon transfers, nerve injury and repair

Question 1

What is a skin graft?

Answer 1

• An Avascular graft
• consists of
  
  • Partial thickness dermal tissue
  • Full thickness dermal tissue

Question 2

What is the donor tissue and what are the goals of tx?

Answer 2

• Autologous

Goals of tx

• Cover deep structures
• Create a barrier to bacteria
• Restore dynamic function
• Prevent joint contractures

Question 3

What are the indications and contraindications for a skin graft?

Answer 3

• A well perfused wound bed over muscle or subcutaneus tissue
• Contraindications
  
  • ​Wounds with exposed bone, nerves or blood vessels

Question 4

what are the indications for split skin grafts STSG?

Answer 4

• Well prefused wound beds where contraction will not lead to decreased joint mobility or scar contracture
• Perferred to dorsal hand wounds

Question 5

Where are the donot sites for STSG and why?

Answer 5

• Anterolateral thigh
• variable based on thickness
• always contain keratinocytes
• thicker graft contains more dermis with hair follicles and sweat glands and contract less
• nutrition is obtained by diffusion from wound bed

Question 6

What is the classification of STSG?

Answer 6

• Thin 0.005-0.012 in
• Intermediate 0.012-0.018 in
• Thick 0.018-0.030in
• meshed vs non meshed
  
  • ​meshed > greater surface area
  • meshed lower incidence of haematoma formation & infection-> better ‘take’ of graft
• ​Outcomes= revascularisation takes 2-3 days