Professional Documents
Culture Documents
Criteria
Wounds that can not be primarily closed
such as circular defects
large void areas with good granular base
wounds that will take longer time to heal by
secondary intention
Skin Grafting
Must be a tissue base that can
provide vascular supply
Good granulation tissue present
Possible to graft over tendon sheath but
rarely over tendon
May take over periosteum, but not over
exposed bone
Do not graft over cartilage or fat
Skin Grafting
Anatomical placement of graft is
important
keep area a non weight bearing surface
consider some contraction occurring
blood supply
Skin Grafting
Types
Biological dressings
Porcine grafts-Xenografts
Amniotic membrane- ( Same species) Allograft
Synthetic graft (wound dressings)
Isograft
Identical twin
Types of Autografts
Split thickness
Full thickness
Epidermis and dermis but not subcutaneous
tissue
Skin Flap
Transplanted neurovascular structures
Composite grafts
Skin and other tissuebone, tendon, cartilage
Skin Grafting
Autografts
split
Full thickness,
we dont use very much
full
Skin Grafting
Concepts
Thin Graft
disadvantage is
contraction
Scalpel
Double edged razor
Humby knife
Blair Knife
Power Dermatome
Zimmer
Brown and Padgett
Daval and Simon
Skin Grafting
Donor Sites
Anterior lateral thigh
buttocks
foot lateral aspect
Skin Grafting
Full thickness Skin
grafts
Epidermis and
entire dermis
resemble normal
skin
Contract less
failure is greater
due to
revascularization
Skin Grafting
Donor sites
Usually small
Pinch grafts
Ellipsed skin
sinus tarsi
lateral hallux
posterior ankle
larger area - inguinal redundancy
Pre op Requirements
aspirin
Post op Requirements
Keep elevated to minimize swelling
Non weight bearing
No activity for 1 2 weeks
Avoid water on the area for 1 2
weeks
Minimize sun exposure for 6 months
Skin Grafting
Treatment
Compression
Inosculation: revascularization
Stent dressing
Adaptic or petrolatum gauze
moisten gauze
Inosculation
process by which revascularization as budding
occurs
Skin Grafting
Remember this!!!
Complications
Seroma
Hematoma
Purulence
3/19/2010
Skin Grafting
Infection
quantitative biopsy
over 106 bacteria
Factors Influencing
Healing of Skin Grafts
Smoking
DM
Protein deficiency
Vitamin deficiency
Medications
Plasmatic
Inosculation
Reorganization
Reinnervation
Plasmatic Stage
24 48 hours
Anchors graft with fibrin
Diffusion of nutrients
Granulation tissue then replaces fibrin
48 72 hours
Revascularization
Vascular proliferation
Bridging phenomenon
Pinking up
Lymphatic drainage by day 4
Circulation is restored by day 7
Skin Flaps
Flaps
stalk
Pedicle Grafts
vascular supply to transposed tissue remains
and nourishes the flap
Rotational
Transpositional
Unilobed
Bilobed
other
Flaps
Rotation flaps
usually used to close
a circular defect
Can also be used to
close a triangular
deficit
outer circumference
is 1 1/2 - 2 time
larger than the
inner0
Flaps
Uni lobed flaps
A to B is the same
diameter as the
defect
the base of the flap
is 30 degrees from
the center line of
the defect
Flaps
Bilobed flaps
extension of the
unilobed flap
the second lobe is
30 degrees from
the first flap
Flaps
Free flaps
Transposition of tissue with muscle and
its attached overlying skin and vascular
supply
latissimus dorsi flap
dorsalis pedis flap
Skin plasties
Incisional procedures to facilitate
skin transposition, coverage or
lengthening
Z-plasty
V-Y- plasty
U-plasty
Tendon Surgeries
Tendon Transfers
Detachment of a tendon of a functioning
muscle at its insertion and relocating to
a new insertion or attachment
Tendon Transposition
rerouting
Rerouting the course of a normal muscle
tendon without detachment
also called tendon translocation
Tendon Surgery
whole muscle transplant
Muscle-Tendon Transplantation
detachment of a muscle tendon at both its
origin and insertion and moving it to a new
location along with its neurovascular
support
Tenosuspension
Important
Tendon Surgery
Straight course of
tendons
Surrounded by
paratenon
Tendon Surgery
Angled course of
tendons
it is surrounded by a
tendon sheath
it is a tubular structure
lined with synovial cells
to allow the tendon to
glide
Tendon Surgery
Principles of tendon Transfers
Improve function
Eliminate forces
Provide active motor power
Provide better stability
eliminate bracing
Tendon Surgery
Fixation of tendons
tendon to tendon
tendon to bone
to an insertion site
Tendon Surgery
Fixation of
transferred
tendons
Tendon to tendon
side to side
weave
Tendon Surgery
Tendon fixation to
bone
Anchors
button hole
Trephine plug
chinese finger trap
three hole suture
tunnel with sling
screw and washer
Tendon Surgery
Tendon Repair
Tendon Surgery
Keep the tendon
in phase
whenever possible
to reduce recovery
period
In phase: try not to put extensors
to flexors and vice versa.