4. Excessive granulation tissue/Skin grafts Flashcards
(21 cards)
Equine wound healing
Limb wounds - slow healing
Distal limb wounds - excessive granulation tissue = fraud flesh
Limb wounds = increased motion, decreased vascularity
Distal limb wounds
healing potential limited
No muscle, extra tissue
Constant movement, contamination
often only 2nd intention healing
Proud flesh
Excessive granulation tissue - delays healing
Tx - resection and bandage, delayed secondary closure, skin grafts
Why proud flesh
Protracted inflammatory phase
= excessive proliferation phase
fibroblasts maintain synthetic role
PMNs stay higher for longer
PMNs release pro-inflammatory phase
Management of proud flesh
Surgical resection
Bandaging
Delayed secondary wound closure
About skin grafts
Simple - performed in a standing horse
Requires granulation bed: healthy, flat, no hematoma, no fissures
Indications for skin grafts
large wounds that won’t heal
Any open wound that can’t be sutured
Skin graft classifications
Pedicle graft - remains connected to donor site
Free graft - completely separated from blood supply
Free graft types
Full thickness - best cosmesis and hair growth
Split thickness
Split thickness dermis amount
Dermis is inversely proportional to ability to survive
Dermis is directly proportional to durability and cosmesis
Graft acceptance stages (4)
Adherence - fibrin
Serum imbibition - nourished by capillary action
Revascularization - 48hrs (neovascularization), 4-5d (revascularization)
Organization - epidermis thickens in first 2wks
Free skin graphs
Island grafts: Pinch and punch
Sheet grafts: solid or meshed
Pinch graft
tent skin, use #11 blade to cut.
Recipient pockets - #15 blade into granulation tissue
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%
Island graft advantages and disadvantages
A: GA not needed, minimal equipment/expertise, complete failure rare
D: Poor cosmesis, little hair growth
Sheet grafts solid vs mesh
mesh covers larger surface than graft itself
Confirms to irregular surface
Full thickness
GA - resist trauma better than split thickness
best cosmetic appearance
Not as readily accepted
Graft failure reasons
Hemorrhage
Motion
INFECTION
Prep of recipient site
Most important for survival of free graft
Clean healthy granulation tissue flush with skin
Ticarcillin
Graft aftercare
Cover with non-adherent dressing
Follow with routine bandage
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
