Excessive Granulation Tissue and Skin Grafting

Question 1

Are wounds on the body or on the limbs more efficient at contraction?

Answer 1

On the body (1mm/d vs. 0.2mm/d)

Question 2

Where does proud flesh most commonly occur?

Answer 2

Distal limb wounds

Question 3

Why is healing potential of distal limb wounds limited?

Answer 3

No muscle/excessive tissue, close to contamination, constant movement

Question 4

What is often the only option for distal limb wound closure?

Answer 4

2nd intention healing

Question 5

Excessive granulation tissue

Answer 5

Proud flesh

Question 6

How do you treat proud flesh?

Answer 6

Resection and bandage, delayed 2* closure, skin grafts

Question 7

Why does proud flesh occur?

Answer 7

Inefficient and protracted inflammatory phase of healing = excessive proliferative phase

Question 8

Maintain their synthetic role rather than differentiating into myofibroblasts (which allow for contracture)

Answer 8

Fibroblasts

Question 9

s stay higher longer and release pro-inflamm. mediators = exuberant granulation tissue

Answer 9

PMNs

Question 10

How does excessive granulation tissue affect healing?

Answer 10

Delays it

Question 11

Why is only sedation and not a local block required to resect proud flesh?

Answer 11

Proud flesh doesn’t have nerves

Question 12

How much will proud flesh bleed during resection?

Answer 12

A LOT

Question 13

In which location is proud flesh most likely to occur?

Answer 13

MC/MT

Question 14

Simple to perform and often performed in a standing sedated horse

Answer 14

Skin grafts

Question 15

How can you ensure the wound bed is healthy enough to receive a skin graft?

Answer 15

Topical abx (Ticarcillin) for a few days

Question 16

What are indications for skin grafts?

Answer 16

Wounds too large to heal otherwise, open wounds that can’t be sutured

Question 17

Type of graft in which the graft remains connected to the donor site

Answer 17

Pedicle graft

Question 18

Type of graft that is completely separated from the donor site blood supply

Answer 18

Free graft

Question 19

Best cosmesis and hair growth but more difficult to survive

Answer 19

Full thickness skin graft

Question 20

Better success but less cosmetic outcome

Answer 20

Split thickness skin graft

Question 21

Epidermis and entire dermis

Answer 21

Full thickness skin graft

Question 22

What is the amount of dermis required for a split thickness graft proportional to?

Answer 22

Durability and cosemesis

Question 23

Where are allograft donor sites most often in horses?

Answer 23

Underneath the mane or ventrum of abdomen

Question 24

How does a graft adhere to a recipient site?

Answer 24

Fibrin

Question 25

Nourisment by plasma-like fluid via capillary action

Answer 25

Serum imbibition

Question 26

How quickly does neovascularization occur at a graft site?

Answer 26

48hr

Question 27

How soon does revascularization occur at a graft site?

Answer 27

4-5d

Question 28

Why does the epidermis of the graft thicken in the first weeks?

Answer 28

Organization of collagen to match recipient site

Question 29

What are the different types of island grafts?

Answer 29

Punch, pinch, and tunnel

Question 30

Which types of island grafts are more often done because they are the least amount of work and most responsive?

Answer 30

Punch and pinch

Question 31

What are different types of sheet grafts?

Answer 31

Solid or meshed

Question 32

GA not required, minimal equipment, minimal technical expertise, complete failure is rare

Answer 32

Punch and pinch grafts

Question 33

Recipient holes of a punch graft are _____ than the harvested skin of the donor site

Answer 33

Smaller

Question 34

Poor cosmesis and little hair regrowth

Answer 34

Punch and pinch grafts

Question 35

How are recipient holes organized?

Answer 35

6mm apart in symmetrical pattern stating distally

Question 36

What is the % chance that a punch graft survives?

Answer 36

60-75%

Question 37

Tent skin and transect 3mm disc w/#11 blade

Answer 37

Pinch graft

Question 38

Where are pinch graft pieces stored prior to placing on the donor site?

Answer 38

Saline moistened gauze

Question 39

What are the 3 main reasons for graft failure?

Answer 39

Hemorrhage, motion, and infection

Question 40

What is the most common cause for graft failure in hoses?

Answer 40

Infection

Question 41

How does hemorrhage cause graft failure?

Answer 41

Hematoma prevents fibrin from attaching graft to wound

Question 42

What bacteria can infect a wound with lower concentration than 10^5 bacteria/g tissue?

Answer 42

B-hemolytic strep and Pseudomonas

Question 43

What is the most important thing for suvival of a free graft?

Answer 43

Prep of recipient site

Question 44

Resist trauma better than split thickness graft and has the best cosmetic appearance

Answer 44

Full thickness sheet graft

Question 45

Allows graft to cover wound larger than itself

Answer 45

Meshing sheet graft

Question 46

Prevents fluid from disrupting graft from fibrinous and vascular attachment

Answer 46

Meshing sheet graft

Question 47

Conforms to irregular surfaces

Answer 47

Meshing sheet graft

Question 48

How do you secure a sheet graft to a wound?

Answer 48

Tack at the wound margin

Question 49

How long should you wait to change the bandage over a graft?

Answer 49

4-5d OR change daily