skin grafts and flaps Flashcards
what is skin grafting and what is it used for?
- Technique in which skin detached and moved to distant (recipient) site
- Can be used to repair almost any type of wound
- Most common reconstructive sx
- Commonly used for: excision of skin tumours, cover areas denuded of skin (burns), wounds in which insuff skin to permit wound closure, when primary closure inc risk for complications or would infere with fx
diff classifications of grafts based on the donor
• Classifications based on donor= autografts (pt own skin), allografts (donr of same species, aka allogenic or homograft) or xenografts (heterograft, another species)
skin grafts based on thickness and their uses
• Class based on thickness = split thickness (thin, intermediate or thick…can be cut at different thicknesses) or full-thickness (entire dermis included w/o underlying fat)
o Depends on amount of dermis from specimen
o Split thickness common to cover large wound or if full thickness impractical
o Full thickness used t cover wounds that are too large to be closed directly
how is the donor site chosen?
do you want a thick or think graft?
• Donor site selected by: closest colour match, testure + hair-bearing qualities, want thickest possible graft w/o jeapordizing healing of donor site, most inconspicuous location
donor site care
• Donor site care: heals by re-epithelialisation of exposed dermis
o Usually place single layer nonadherent, fine-mesh gauze directly on site, then absorbent gauze
o Possible membrane dressing used (Op-Site): transparent, allows observation w/o removal, allows pt to shower w/o fear of saturating drsg
o After healing, pt to keep site soft and pliable with cream – keep away from possible thermal + mechanical injury + sunlight (as sensitive)
nursing interventions for donor site care
• Nursing Interventions
o Keep affected part immobilized
o For facial graft, strenuous activity avoided
o May use splint for immobilization of hand or arm
o Lower extremity kept elevated b/c capillary connetions fragile + may rupture w venous P
o When ambulation permitted, elastic stocking used to counteract venous p
o Instruct pt to inspect dressing daily – report signs of infection (fluid must be drained)
o When graft pink, is vascularised
o After 2-3wk, mineral oil or lanolin cream applied to moisten graft
o Loss of sensation in graft area for prolonged period of time application of heating pads + sun avoided to prevent burns + skin trauma
skin flaps
advantages?
major complic?
- = segment of tissue that remains attached at one end, while other end moved to recipient area
- Survival depends on functioning arterial + venous blood supplies + lymphatic drainage in pedicle or base (where attached)
- May consist of skin, mucosa, muscle, adipose, tissue, omentum + bone
- Used for wound coverage + provide bulk (esp when underlying structures exposed), repair defects from congenital deformity, trauma, tumour ablation
- Advantages: Aesthetic solution b/c flap retains colour + texture, more likely to survive than graft, can be used to cover nerves, tendons + blood vessels
- Requires multiple surgical procedures
- Major complication = necrosis of pedicle or base d/t failure of blood supply
- Free flaps: completely severed + transferred to other site, receives early vascular supply from microvascularanatomosis with vessels + recipient site (using microvascularsx), done in one sx
how to pack wound
apply as single layer directly onto wound surface using sterile gloves/forceps until all wound surfaces are in contact with moist gauze including dead space from sinus tracts, tunnels, undermining
should a packed wound have gauze touching the periowuund skin
no no
how to cover a packed wound
put dry sterile 4x4 over moist gauze and cover with abd pad, surgipad, or gauze
if using packing strips how should you get it out of bottle and insert
use sterile scissors to cut the amount youll use, dont let touch the side of bottle.
pt reports sensation that something has given way under drsg what do
observe wound for inc drainage or dehiscence or evisceration
protect wound. cover w sterile moist drsg
instruct pt to lie still
stay w pt and monitor VS
notify
what do if wound bleeds during drsg change
observe color/amount of drainage. if excessive may need to apply direct drsg
inspect area along drsg and directly underneath pt to det amount of bleeding
get VS as nec
notify
what do if theres deep wound and suspected retention of drsg in cavity
-irrigate copiously w prescribed soln to loosen drsg. use continuous ribbon or stip of gauze to dress deep wounds
what do if wound drainage is damaging healthy tissue
protect healthy tissue w skin barrier like hydrocolloid. wounds w lg amounts of drainage may benefit from occlusive drainage collection device
