Skin Grafting Flashcards
What are 3 indications for skin grafting?
Skin defects on the extremities
Extensive burn wounds
Adjunct to other reconstructive procedures
What are 2 general classifications for skin grafts?
Donor-Host Relationship
Thickness
What are the 3 types of Donor-Host Relationship?
Autograft
Allograft
Xenograft
Why do we not usually use allografts and xenografts?
They are often rejected by the patient
What are the 2 types of Thickness?
Full-thickness
Split-thickness
What thickness graft is typically preferred in small animal (cats and dogs)?
Full thickness
What thickness graft is typically used in equine medicine?
Split thickness
What 2 types of recipient bed are ideal?
Healthy granulation bed
Fresh wound with sufficient blood supply to produce granulation tissue
Which type of wound bed is preferred in most instances for skin grafts?
Healthy granulation tissue
Where will skin grafts not “take”?
Exposed tendon or bone
-Not a good blood supply, so allow granulation tissue to form first, then can do skin graft
Chronic granulation tissue
-Tissue is less vascular
What is a cortical fenestration “forage”?
Drill holes in nearby bone through cortex into medullary cavity
What is the purpose of a cortical fenestration “forage”?
Speeds granulation tissue formation over exposed bone because blood clots serve as a matrix for granulation tissue
What are 3 signs that granulation tissue is ready for grafting?
Granulation tissue is pink and glistening
Surface is smooth
Wound contraction and epithelial migration seen at wound margin
What are 3 things we need for a good and successful skin graft?
Good wound bed
Graft needs to be prepared
Graft needs to remain in contact with recipient bed
What are the 3 skin grafting techniques?
Sheet
Punch
Strip
NOTE: Strip doesn’t have a good advantage over punch so we won’t cover strip.
What are 3 types of sheet graft?
Full-thickness
Split-thickness
Mesh, sieve, pie-crust
What is the benefit to performing a mesh, sieve, pie-crust graft?
Helps graft remain in better contact with recipient bed by allowing fluid drainage
What are 2 types of punch graft?
Seed, pinch
Stamp
What 2 things does a full thickness skin graft consist of?
Epidermis
Dermis
What 2 things does a full thickness skin graft include?
Hair follicle
Adnexal structures
Why is a full thickness skin graft often used?
Best cosmetic appearance and function
How do you prepare the recipient bed?
Lightly scrape with scalpel blade to remove surface debris and expose capillaries
Cover bed with moist CHX sponges
Why is it good to prepare the recipient bed BEFORE you prepare the skin graft?
Allows you to get bleeding under control and avoid having excess fluid in the graft.
What are 2 reasons you would make a pattern for a skin graft?
Recipient site has irregular borders
Exact fit is desired
NOTE: Pope always makes a pattern so he doesn’t fuck up the graft
What should you always do when making a skin graft pattern?
Mark which side of the pattern is the external side so you don’t make a mirror image by accident!
NOTE: Pope also marks direction of hair growth to try and maintain as much cosmetic appeal as possible for client
What is the easiest method for harvesting a graft?
Dissect the graft from the donor site DEEP to cutaneous trunci muscle
How do you prepare the graft?
Remove cutaneous trunci muscle and SQ tissue
NOTE: best to stretch graft with suture or needles to hold graft in original size
How do you know that your graft is properly prepared?
Bulbs of hair follicle will be visible
Why is preparing the graft such an important step?
Enhances revascularization of the graft
What is a mesh graft?
A sheet graft with parallel rows of staggered slits
What are 3 benefits to using a mesh graft?
Allows expansion of the graft
Allows drainage of blood and serum
Allows graft to conform to uneven surface
How much can you expand a mesh graft?
The degree of expansion is determined by the number of rows of slits
How do you apply the graft?
Place on the wound and then manipulate AS LITTLE AS POSSIBLE.
NOTE: Minimize manipulation because fibrin seal forms VERY fast. Don’t want to disrupt.
Why would you place sutures or staples in the middle of the graft?
To secure the graft and minimize movement.
What is a punch/seed graft?
A full-thickness plug of skin placed in a granulation bed
What is the purpose of a punch/seed graft?
To enhance epithelialization
What must you have already before you consider a punch/seed graft?
Granulation tissue
T/F: Punch/seed grafts are commonly used in small animal surgery.
False
How do you place a punch/seed graft?
Just push them in! Otherwise, not secured
NOTE: Pope will use a punch biopsy one size bigger for the donor site than the recipient site so that it’s a snug fit.
What are 4 components to post-operative care for skin grafts?
Antibiotic ointment and non-adherent dressing
Absorbent secondary layer
Splint or cast wound if over joint
Change dressing in 24-48 hours
-Wait 48hrs if you can to allow fibrin seal to strengthen
Which is usually established faster, venous or arterial supply?
Arterial supply
What 2 things are common to see in a skin graft?
Venous congestion
Edema (lymphatics are a little confused)
What are the 3 ways that vessels heal in a skin graft?
Plasmatic imbibition
Inosculation
Vessels grow completely up into dermis
What is plasmatic imbibition?
Absorption of plasma and tissue gains nutrients that way
What is inosculation?
Two blood vessels (one in donor site, and one in recipient site) gain direct contact
What can over growth of normal superficial bacteria cause?
Superficial loss of epidermis
NOTE: This is NOT an infection
If not black and dry or white and slimy, skin graft should be…
OK!
NOTE: Skin does have layers, don’t decide the graft has failed too quickly, epidermis may slough leaving normal intact dermis behind.
What is a good principal to always remember with wound management?
KISS
Keep It Simple Sweetheart
