Skin Grafts & Biological Skin Substitutes - Class 4 Flashcards
skin grafts
split-thickness
full-thickness
split thickness
all of epidermis and part of dermis of varying thickness
split thickness can tolerate
less ideal conditions
when are split thickness skin grafts used
more fxnal than cosmetic reasons
resurface large wounds
full thickness skin grafts
all of epidermis and entire thickness of dermis included
full thickness skin grafts limited to
small, clean, uncontaminated and well vascularized wounds
full thickness donor sites
closed primarily
how are skin grafts retrieved
humby knife
power-driven dermatome
dressing of graft site must provide
uniform pressure to immobilize graft
dressing of graft prevents
shearing
formation of seromas or hematomas under graft
types of dressings
bolster w/ xeroform/adaptic
compressive
NPWT
how long is a dressing left on
5 days
unless signs of complication
interventions for dressing
leg elevation and complete bed rest
dressing of donor site
FTSG
STSG
FTSG donor site
dressed as other wounds closed primarily
STSG donor site
dressings that promote rapid epithelialization
causes little pain
requires little care
inexpensive
low rate of infection
STSG examples
occlusive dressings (duoderm)
semi-occlusive (tegaderm)
semiopen dressings (xeroform)
graft failure
poor graft contact or adherence to wound bed
hematoma/seroma formation under graft
movement or shearing of graft on wound bed
poor recipient site from poor vascularity
wound infection
technical error (applying graft upside down)
biological substitutes
intended for permanent replacement or as a temporary biological dressing
biological skin subs decrease ____ and promote _____
bacterial count
promote a sterile wound
biological skin subs slow
loss of water, protein and electrolytes
biological skin subs reduce
pain and fever
biological skin subs restore
fxn
biological skin subs –> prevent desiccation
by facilitating early motion
provide coverage of vessels, tendons and nerves to prevent desiccation
biological skin subs
allograft/homograft
xenograft/heterograft
epithelial cells
allograft dermis
bilayer collagen matrices
allograft/homograft
cadaveric grafts
transplanted w/in the same species
xenograft/heterograft
pig skin grafts
one species to another
epithelial cells
grown in culture from biopsy sized cultures
allograft dermis
not rejected b/c of immunologically inert
can be eventually incorporated
bilayer collagen matrices are made of
bovine collagen
bilayer collagen matrices act as
scaffold for influx of fibroblasts and blood vessels that eventually replace it
bilayer collagen matrices simulates
epidermis to control fluid loss
s/p plastic surgery bedrest
complete and strict bedrest x 5 days
how long is dressing left in place –> s/p plastic surgery
left in place for 5 days
unless signs of flap failure or graft infection
s/p plastic surgery should do
leg elevation
POD #5 graft/flap assessment for take
graft take assessed y percentage of adherence
ambulation –> s/p plastic surgery
dependent on surgeons orders
OOB –> chair only v. ambulation
weight bearing status
WB status –> s/p plastic surgery
dependent on MD
surgical site
s/p plastic surgery –> donor site
primary closure
open STSG donor site
