Grafts & Flaps

Question 1

Define skin graft & mention its types

Answer 1

Segmment of epidermis & dermis completely cut off from blood supply in donor site & transferred to recipient site, nutrition depends on diffusion from serum
Split or full thickness

Question 2

Indications of Theirsch graft

Answer 2

Cover:
1. Large areas of granulation tissue
2. Deep burns
3. After malignancy resection

Question 3

List adv & dis of split thick skin graft

Answer 3

Adv: early separation & application, high take, donor site heal spontaneously, detect recurrence of malignancy, cover wide areas
Dis: liable to contracture (2ry) & pigmentation, dec cosmosis, resistance to trauma & sensation

Question 4

List adv & dis of full thick skin graft

Answer 4

Adv: direct closure of donor site, better cosmosis, sensation & resistance to trauma, minimal contracture
Dis: limited to donor site + site left at donor site, less take, asepsis must be perfect (?favorable granulation tissue)

Question 5

List stages of graft take

Answer 5

1. Plasmatic imbibition (<3 days)—>nutrients from bed by diffusion
2. Inosculation (3-5 dys) —>cut ends of vessels connect with bed vessels
3. Angiogenesis (>5dys) —> new vessels into graft

Question 6

Mention causes of graft failure

Answer 6

1. Poor wound bed (tendons, bone, radiation)
2. Sheer
3. Hematoma/seroma
4. Infection

Question 7

Mention indications of:
1. Full thickness skin graft
2. Skin flaps

Answer 7

1. Cover facial burns, palms & soles, pressure points
2. Wound with poor vascular bed, more complex reconstruction is needed, when sensation is required

Question 8

List stages of a pressure sore

Answer 8

1. Non-blanchable erythema
2. Partial thickness skin loss
3. Full thickness skin loss
4. Full thickness skin & tissue loss
   Unstageable pressure injury: covered by eschar may be 3 or 4
   Suspected tissue injury depth unknown: purple or maroon area with intact skin may be blood filled blister

Question 9

Mention the principles of management of bed sores

Answer 9

1. Pressure release: by turning pt every 2 hrs. Adjuncts include air-filled mattresses
2. Debridement: 1st step in surgery, complete excision of bursa + partial ostectomy to evaluate osteomyelitis
3. Wound management: conservative measures as wet to dry dressing to get healthy granulation tissue
4. Improve general condition
5. Reconstructive Surgery: fasciocutaneous perforator flaps to minimize donor site morbidity & allow for further future harvest if needed. Patients are positioned flat in air fluid bed for 4 wks following surgery
6. Prophylaxis: reposition every 2 hrs, air mattress, skin care, improve general condition