Wound Closure

Question 1

Primary Closure

Answer 1

Requires clean, minimally contaminated wound
Tension-relieving sutures
Tissue apposition sutures

Question 2

Delayed Primary Closure

Answer 2

Clean, debride, bandage to keep clean
Change bandage every day to assess granulation tissue and cleanliness of the wound
Suture laceration using both tension relieving sutures and tissue apposition sutures

Question 3

Full Thickness Graft

Answer 3

Includes both epidermis and dermis
Gives best cosmetic result

Question 4

Partial/Split Thickness Graft

Answer 4

Best chance at success, less cosmetic result

Question 5

What are the healing stages of skin grafts?

Answer 5

Adherence (day 1)
Plasmic inhibition (days 1-4)
Revascularization (days 3-7)
Final organization

Question 6

Best donor sites for skin grafts

Answer 6

Side of neck (under mane)
Ventral abdomen

Question 7

Pinch Grafting

Answer 7

Skin tented and cut off with scalpel blade
8-10mm in diameter
Remove subcutaneous tissue
Make pockets in granulation tissue, place grafts into pockets

Question 8

Punch Grafting

Answer 8

Similar instructions to pinch grafting
8mm punch at donor site
6mm punch at granulation bed

Question 9

Tunnel Grafting

Answer 9

Long narrow strips of skin from the donor site
Long forceps tunneled under granulation tissue
Skin is pulled through granulation tissue
Suture graft to surrounding skin
More skin placed into the wound than pinch/punch
generally requires general anesthesia

Question 10

Sheet Grafting

Answer 10

Requires specialized equipment
greatest chance for failure
Meshing
Best performed with a dermatome

Question 11

Pedicle Grafting

Answer 11

Move skin from area close to wound to cover defect leaving some vascular supply intact
Used in head region (cover sinus fistulas)
Requires general anesthesia