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3 Cards in this Set
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Describe split-thickness skin grafts |
They can be meshed or unmeshed Typically meshed at ratios of 1:1 or 3:1 with the ration selected depending on the size oft he defect that needs to be grafted and the skin available Meshing facilitates expansion of the graft for coverage of more extensive wound defects May be left unmeshed and used to cover a wound as a sheet graft, a sheet graftbavoids the meshed pattern scarring associated with m3shed skin grafts- better cosmetic appearance |
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Reasons for failure of a graft |
Hematoma- can form beneath a graft preventing adherence and promote graft loss Prevention includes meticulous perioperative haemostasis and appropriate post op dressings Dressings over the graft must provide lubrication to prevent desiccation, appropriate compression to eliminate the potential space between skin graft and the wound bed and local immobilisation to prevent shearing of the graft Lubricating gauze such as = adaptic, xerform or xeroflo initially is placed directly over the skin graft, followed by a layer of cotton balls, cotton sheets, gauze, saturated in a solution such as Bunnell's (benzalkonium chloride, acetic acid and glycerin) or mineral oil A convex wound may only require a simple dressing under which compression can occur naturally A concave wound often requires a tie over dressing (bolster or stent) to compress the skin graft against the surface of the wound defect Graft survival also enhanced by strict immobilisation |
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Post op management and follow up of grafts |
Dressings over an UE skin graft typically removed in 4 to 7 days Wound reevaluated - by this time the skin graft should be adherent to the wound bed Important to maintain a mosit mosit/lubricated environment to prevent the persistent risk of desiccation of the skin graft and to facilitate complete healing This can be accomplished by either continued wet-to-wet dressing changes or the application of a lubricating agent such as and antibacterial ointment (bacitracin) Once epithelialization of the skin graft is recognised ointments and dressings can be discontinued and simple moisturisation cream (eucerin) can be commenced Once adherence of the skin graft is recognised and as long as there are no significant underlying injures rehab can be intiated and rapidly advanced Neurovasculat, tendon and bone injuries influence the rehab plan |
