Ch19 Grafts Flashcards by Malindi Haggett

What is an autograft? homgraft and xenograft?

An autograft is a graft taken from a donor site on an indi-
vidual and placed at a recipient site on that same individual,

A homograft is taken from an individual and trans-
planted to another individual of the same species.

A xenograft (heterograft) and is a graft that is transplanted between species (e.g., pig to human).

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What is a FTSG? Split thickness skin graft? and composite graft?

Full-thickness skin grafts (FTSGs) contain the entire epidermis and
dermis and preserve adnexal structures.

Split-thickness skin grafts (STSGs) are composed of the epidermis and partial-
thickness dermis with few or no adnexal structures.

Composite grafts consist of skin and a second type of tissue.

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Advantages of grafts?

Thin - so allow early detection of recurrence

No manipulation of surrounding tissue - good if there is concern about tumour margins

Good if patietns cannot tolerate more complex procedures

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Disadvantages of grafts?

creates a second surgical site

Cosmesis is not always as good - if colour matching etc

Denervation of graft site

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What are the three stages of graft survival?

Imbibition is the first stage and is an ischemic period that
lasts for the** first 24–48 h.**
- During this time, fibrin attaches the graft to its bed, the graft is sustained by
the plasma exudate from the wound bed, and nutrients are obtained by passive diffusion

inosculation, is a process of revascularization, resulting in the linkage of the graft’s dermal vessels to those present in the recipient bed
- begins as early as** 48–72 h and lasts for 7–10 days**

**neovascularization **and occurs through capillary ingrowth to the graft from the recipient base and sidewalls.

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T or F

exposed bone and cartilage are good substrates for grafts

F -
delayed grafting at sites initially devoid of periosteum or
perichondrium allows for the development of granulation
tissue and an improved chance of subsequent graft survival
through successful inosculation.

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The rate at which a skin graft revascularizes is a function of both the graft
thickness and the recipient bed vascularity.

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Under optimal healing conditions, full circulation can be restored to the
graft between the 2th and 4th day

F - between the 4th and 7th

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Advantages of FTSG over STSG

better overall appearance when compared with STSGs because they better retain functions such as sweating, hair growth, and pigment production.
more complete filling of deeper surgical defects and increases the likeli-
hood of smooth surface contour.
less wound contracture when compared with STSGs.

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Disadvantages of FTSG or STSG?

the increased thickness of FTSGs results in an increased metabolic demand and a higher rate of graft failure

Limit in the overall size of FTSG (to 4 -5 cm)

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Factors contributing to the donor site selection:

Skin colour
Skin Texture
Amount of photodamage
Presence or absence of hair

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It is recommended to oversizing the harvested graft by 10–20% to compensate for the inevitable graft contracture

Controversial - oversizing the graft is controversial as some
authors recommend that the initial size of the full-thickness
skin graft should be smaller than the defect it will cover

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True or False: Inosculation involves the formation of brand-new blood vessels from the wound bed.

False — it reconnects preexisting vessels; neovascularization forms new vessels.

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True or False: FTSGs have higher metabolic demands than STSGs and are more likely to fail on poorly vascularized beds.

True.

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True or False: Graft edema during the imbibition phase indicates early graft failure.

False — edema is expected and resolves as lymphatic reconnection develops by Day 7.

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True or False: Meshing a STSG increases surface area and reduces fluid accumulation under the graft.

True.

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True or False: CD68+ histiocytes are a specific marker of graft rejection.

False — CD68 is a general macrophage marker; not specific to rejection.

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True or False: STSGs contract less than FTSGs and offer better cosmesis.

False — STSGs contract more and have inferior cosmetic results.

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True or False: Composite grafts have the highest metabolic demand among graft types.

True.

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True or False: The most important factor for graft survival in the early post-op period is preventing shear.

True.

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True or False: If a graft necroses due to hematoma, it should be removed and replaced immediately.

False — necrosed grafts can act as biological dressings and should not be removed unless infected.

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True or False: STSG donor sites re-epithelialize via adnexal structures in 2–3 weeks.

True.

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True or False: FTSGs should be oversized by 10–20% due to primary contraction.

True.

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True or False: After bolster removal at Day 7, the graft can be treated like normal skin.

False — while vascularized, it remains fragile and should be protected for several more weeks.

True or False: Smoking should be stopped at least 48 hours before grafting to improve vascularity.

True.

True or False: Vitamin E, ginkgo, and fish oil should all be stopped pre-op to minimize bleeding.

True.

True or False: Grafts over irradiated tissue or exposed bone/tendon are more prone to failure.

True.

True or False: Routine perioperative antibiotics are necessary for all graft procedures to prevent graft failure.

False

True or False: The most common cause of early graft loss is elevation of the graft by hematoma or seroma.

True

True or False: It is best practice to discontinue anticoagulants for all skin graft surgeries, regardless of thrombotic history.

False — consultation with the prescribing physician is required.

True or False: Patients should be advised to avoid exercise and heavy lifting for 5–7 days postoperatively to minimize bleeding risk.

True — as this raises BP and increases bleeding risk.

True or False: Cool compresses and head elevation can help reduce postoperative swelling in craniofacial grafts.

True

True or False: FTSGs can be hand-meshed to allow for better fluid drainage in patients at high risk for hematoma.

True

True or False: Infection at the graft site is uncommon and does not require immediate antibiotic therapy.

False — infection should be treated quickly.

True or False: A culture of expressible fluid from an infected graft is recommended to guide antibiotic therapy.

True

True or False: The use of a bolster dressing or compression helps prevent hematoma by compressing wound edges and vessels.

True

True or False: There is strong evidence that perioperative antibiotics reduce graft failure in all patients.

False

True or False: The final cosmetic outcome of FTSGs may take months to years to fully mature.

True

True or False: Spot dermabrasion for contour correction can be considered as early as 6 weeks post-op.

True

True or False: Manual dermabrasion using a sterilized drywall-sanding screen is a low-cost, effective alternative to laser resurfacing.

True

True or False: STSGs are more prone to color and texture mismatch compared to FTSGs.

True

True or False: Graft contracture is more significant in thicker grafts like FTSGs.

False

True or False: Graft contracture poses a particular risk when placing grafts over joints or free margins such as the eyelids or nasal ala.

True

True or False: Proper patient education and postoperative follow-up are essential to prevent long-term complications and manage expectations.

True

True or False: The decision to discontinue anticoagulants should be individualized and discussed with the prescribing physician.

True

True or False: Spot dermabrasion should be routinely performed at 6 weeks post-op for all patients with FTSGs.

False

True or False: Skin grafts are less reliable than flaps in early healing stages due to limited early vascularity.

True

True or False: The most critical postoperative factor for graft survival is prevention of shear forces on the graft.

True

True or False: Patients should be encouraged to frequently inspect and gently touch the dressing to monitor healing progress.

False

True or False: Strenuous activity post-op can elevate blood pressure and contribute to graft failure via bleeding.

True

True or False: Crutches and leg elevation are important in lower extremity grafts to reduce ambulation and venous congestion.

True

True or False: A dressing that is tightly adhered to the graft should be rapidly removed at post-op day 7 to avoid tissue damage.

False

True or False: The correct method for removing a dry bolster is to first moisten it with saline and remove it slowly from the edge.

True

True or False: A violaceous appearance of an FTSG at 1 week is normal and should not immediately be interpreted as necrosis.

True

True or False: A necrotic graft should be debrided promptly to prevent infection and prepare the wound for re-grafting.

False

True or False: Even a fully necrotic graft can serve as a biologic dressing to support secondary healing.

True

True or False: A “gummy” or “spongy” texture with forceps is a reliable sign of FTSG necrosis.

True

True or False: After bolster removal, hydrogen peroxide can be used to clean debris from the graft site.

True

True or False: Patients who cannot perform their own wound care should have a caregiver present during instruction or be assigned home health nursing.

True

True or False: Most grafts transition from violaceous to pink by around 2 weeks postoperatively.

True

True or False: A dressing must be worn continuously for at least 6 weeks after grafting to ensure complete healing.

False

True or False: At one month, most patients can begin treating the graft like normal skin, including applying cosmetics.

True

True or False: STSGs typically appear pink or skin-colored as early as the 1-week dressing change.

True

True or False: Excess peripheral tissue from an oversized STSG can be left in place permanently to support healing.

False

True or False: Fenestrations in a meshed STSG may take up to 6–8 weeks to fully re-epithelialize.

True

True or False: STSGs are more prone to long-term dryness, scaling, and hyperkeratosis than FTSGs.

True

True or False: Liberal application of emollients like petrolatum is recommended for STSGs long-term to improve texture and hydration.

True

True or False: Nasal vestibular support post-op can be improved using a dental roll bolster or nasal packing.

True

True or False: Ice packs every 2–4 hours for 15–20 minutes in the first 72 hours reduce swelling and improve graft survival.

True

True or False: Broad-spectrum antibiotics are recommended post-op due to nasal bacterial colonization.

True

True or False: Suture removal is typically performed around 1 week after composite grafting.

True

True or False: A pink graft at suture removal suggests partial necrosis and requires immediate debridement.

False

True or False: Dark graft appearance at 1 week may represent superficial necrosis, not full graft loss.

True

True or False: Necrotic debris should be preserved in case viable graft components remain underneath.

True

True or False: Revision surgery should be performed immediately in cases of dark graft discoloration.

False

True or False: Revision of composite grafts is typically delayed for 6–12 months to allow tissue maturation.

True

True or False: Free cartilage grafts cannot survive without a flap or overlying vascularized tissue.

False

True or False: Studies have shown that free cartilage can survive beneath full-thickness skin grafts.

True

True or False: The “reverse tongue-in-groove” technique enhances graft stability and vascular access.

True

True or False: Oversizing the graft by 5–10% is necessary in reverse tongue-in-groove techniques.

True

True or False: Sandwich grafts include skin-cartilage-skin layers harvested en bloc from the ear.

True

True or False: In sandwich grafts, removing a small amount of skin at each end exposes cartilage “pegs” for stabilization.

True

True or False: Mucosal integrity beneath the graft provides a viable vascular base and reduces the need for full skin coverage.

True

True or False: Tie-over sutures through cartilage help prevent dislocation and improve healing.

False

True or False: Excess cartilage should be avoided to reduce the risk of contour irregularities.

True

True or False: Strong, braided absorbable sutures like 4-0 Vicryl are appropriate for securing cartilage grafts.

True

True or False: Placing large circular cartilage grafts without adjustment can collapse the nasal airway.

True

True or False: Cartilage is critical for maintaining the structure and function of the nose and ears.

True

True or False: Loss of alar cartilage can cause nasal valve collapse and impaired airflow during inspiration.

True

True or False: Composite grafts are composed solely of cartilage.

False

True or False: A composite graft is a modified full-thickness skin graft that includes cartilage.

True

True or False: Composite grafts survive primarily by revascularization from their base and edges.

True

True or False: The size of composite grafts should not exceed 1.5 cm in diameter to optimize survival.

True

True or False: Rich vascular networks in the nose and ear help support composite graft survival.

True

True or False: A hinge flap or delayed healing can improve the base for composite grafts.

True

True or False: Smoking and diabetes improve composite graft outcomes.

False

True or False: The conchal bowl is a common donor site for thicker, sebaceous nasal defects.

True

True or False: Cartilage grafts with perichondrium alone have lower nutritional demands than composite grafts.

True

True or False: Using a flap for surface coverage allows more flexibility than a true composite graft.

True

True or False: Excessive contraction during second intention healing can impair function at the nasal valve.

True

True or False: Free cartilage grafts should be oversized by 10–15% to allow subdermal tucking.

True

True or False: Placing sutures directly through cartilage is generally preferred to prevent graft migration.

False

True or False: Peripheral soft tissue pockets help secure cartilage grafts without direct suturing through cartilage.

True

True or False: For alar defects <1 cm, it is best to cover the entire defect base with cartilage.

False

True or False: Cartilage struts should be placed at least 2–3 mm above the alar rim to avoid a ridged appearance.

True

True or False: Grafts should be trimmed to fit snugly into the defect without bulging or inward displacement.

True

True or False: A circular graft that doesn’t seat well can be subdivided into smaller parts for better contouring.

True

Ch19 Grafts Flashcards

(109 cards)