4. Excessive granulation tissue/Skin grafts Flashcards Preview

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Flashcards in 4. Excessive granulation tissue/Skin grafts Deck (21)
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1

Equine wound healing

Limb wounds - slow healing
Distal limb wounds - excessive granulation tissue = fraud flesh
Limb wounds = increased motion, decreased vascularity

2

Distal limb wounds

healing potential limited
No muscle, extra tissue
Constant movement, contamination
often only 2nd intention healing

3

Proud flesh

Excessive granulation tissue - delays healing
Tx - resection and bandage, delayed secondary closure, skin grafts

4

Why proud flesh

Protracted inflammatory phase
= excessive proliferation phase

fibroblasts maintain synthetic role
PMNs stay higher for longer
PMNs release pro-inflammatory phase

5

Management of proud flesh

Surgical resection
Bandaging
Delayed secondary wound closure

6

About skin grafts

Simple - performed in a standing horse
Requires granulation bed: healthy, flat, no hematoma, no fissures

7

Indications for skin grafts

large wounds that won't heal
Any open wound that can't be sutured

8

Skin graft classifications

Pedicle graft - remains connected to donor site
Free graft - completely separated from blood supply

9

Free graft types

Full thickness - best cosmesis and hair growth
Split thickness

10

Split thickness dermis amount

Dermis is inversely proportional to ability to survive
Dermis is directly proportional to durability and cosmesis

11

Graft acceptance stages (4)

Adherence - fibrin
Serum imbibition - nourished by capillary action
Revascularization - 48hrs (neovascularization), 4-5d (revascularization)
Organization - epidermis thickens in first 2wks

12

Free skin graphs

Island grafts: Pinch and punch
Sheet grafts: solid or meshed

13

Pinch graft

tent skin, use #11 blade to cut.
Recipient pockets - #15 blade into granulation tissue

14

Punch graft

Harvest under mane and ventrolateral abdomen - excise SQ fascia and fat
Recipeint holes - created first, start distally, one size smaller than biopsy
60-75%

15

Island graft advantages and disadvantages

A: GA not needed, minimal equipment/expertise, complete failure rare
D: Poor cosmesis, little hair growth

16

Sheet grafts solid vs mesh

mesh covers larger surface than graft itself
Confirms to irregular surface

17

Full thickness

GA - resist trauma better than split thickness
best cosmetic appearance
Not as readily accepted

18

Graft failure reasons

Hemorrhage
Motion
INFECTION

19

Prep of recipient site

Most important for survival of free graft
Clean healthy granulation tissue flush with skin
Ticarcillin

20

Graft aftercare

Cover with non-adherent dressing
Follow with routine bandage

21

Conclusion of wounds

distal limb wounds can be devastating and expensive
Lack of soft tissue covering and presence of vital structures makes it challenging
Accurate dx and tx, aggressive debridement and immobilization