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Small Animal Surgery > Skin Grafting > Flashcards

Skin Grafting Flashcards

1
Q

What are 3 indications for skin grafting?

A

Skin defects on the extremities
Extensive burn wounds
Adjunct to other reconstructive procedures

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2
Q

What are 2 general classifications for skin grafts?

A

Donor-Host Relationship

Thickness

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3
Q

What are the 3 types of Donor-Host Relationship?

A

Autograft
Allograft
Xenograft

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4
Q

Why do we not usually use allografts and xenografts?

A

They are often rejected by the patient

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5
Q

What are the 2 types of Thickness?

A

Full-thickness

Split-thickness

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6
Q

What thickness graft is typically preferred in small animal (cats and dogs)?

A

Full thickness

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7
Q

What thickness graft is typically used in equine medicine?

A

Split thickness

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8
Q

What 2 types of recipient bed are ideal?

A

Healthy granulation bed

Fresh wound with sufficient blood supply to produce granulation tissue

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9
Q

Which type of wound bed is preferred in most instances for skin grafts?

A

Healthy granulation tissue

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10
Q

Where will skin grafts not “take”?

A

Exposed tendon or bone
-Not a good blood supply, so allow granulation tissue to form first, then can do skin graft

Chronic granulation tissue
-Tissue is less vascular

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11
Q

What is a cortical fenestration “forage”?

A

Drill holes in nearby bone through cortex into medullary cavity

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12
Q

What is the purpose of a cortical fenestration “forage”?

A

Speeds granulation tissue formation over exposed bone because blood clots serve as a matrix for granulation tissue

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13
Q

What are 3 signs that granulation tissue is ready for grafting?

A

Granulation tissue is pink and glistening
Surface is smooth
Wound contraction and epithelial migration seen at wound margin

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14
Q

What are 3 things we need for a good and successful skin graft?

A

Good wound bed
Graft needs to be prepared
Graft needs to remain in contact with recipient bed

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15
Q

What are the 3 skin grafting techniques?

A

Sheet
Punch
Strip

NOTE: Strip doesn’t have a good advantage over punch so we won’t cover strip.

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16
Q

What are 3 types of sheet graft?

A

Full-thickness
Split-thickness
Mesh, sieve, pie-crust

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17
Q

What is the benefit to performing a mesh, sieve, pie-crust graft?

A

Helps graft remain in better contact with recipient bed by allowing fluid drainage

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18
Q

What are 2 types of punch graft?

A

Seed, pinch

Stamp

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19
Q

What 2 things does a full thickness skin graft consist of?

A

Epidermis

Dermis

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20
Q

What 2 things does a full thickness skin graft include?

A

Hair follicle

Adnexal structures

21
Q

Why is a full thickness skin graft often used?

A

Best cosmetic appearance and function

22
Q

How do you prepare the recipient bed?

A

Lightly scrape with scalpel blade to remove surface debris and expose capillaries
Cover bed with moist CHX sponges

23
Q

Why is it good to prepare the recipient bed BEFORE you prepare the skin graft?

A

Allows you to get bleeding under control and avoid having excess fluid in the graft.

24
Q

What are 2 reasons you would make a pattern for a skin graft?

A

Recipient site has irregular borders
Exact fit is desired

NOTE: Pope always makes a pattern so he doesn’t fuck up the graft

25
Q

What should you always do when making a skin graft pattern?

A

Mark which side of the pattern is the external side so you don’t make a mirror image by accident!

NOTE: Pope also marks direction of hair growth to try and maintain as much cosmetic appeal as possible for client

26
Q

What is the easiest method for harvesting a graft?

A

Dissect the graft from the donor site DEEP to cutaneous trunci muscle

27
Q

How do you prepare the graft?

A

Remove cutaneous trunci muscle and SQ tissue

NOTE: best to stretch graft with suture or needles to hold graft in original size

28
Q

How do you know that your graft is properly prepared?

A

Bulbs of hair follicle will be visible

29
Q

Why is preparing the graft such an important step?

A

Enhances revascularization of the graft

30
Q

What is a mesh graft?

A

A sheet graft with parallel rows of staggered slits

31
Q

What are 3 benefits to using a mesh graft?

A

Allows expansion of the graft
Allows drainage of blood and serum
Allows graft to conform to uneven surface

32
Q

How much can you expand a mesh graft?

A

The degree of expansion is determined by the number of rows of slits

33
Q

How do you apply the graft?

A

Place on the wound and then manipulate AS LITTLE AS POSSIBLE.

NOTE: Minimize manipulation because fibrin seal forms VERY fast. Don’t want to disrupt.

34
Q

Why would you place sutures or staples in the middle of the graft?

A

To secure the graft and minimize movement.

35
Q

What is a punch/seed graft?

A

A full-thickness plug of skin placed in a granulation bed

36
Q

What is the purpose of a punch/seed graft?

A

To enhance epithelialization

37
Q

What must you have already before you consider a punch/seed graft?

A

Granulation tissue

38
Q

T/F: Punch/seed grafts are commonly used in small animal surgery.

A

False

39
Q

How do you place a punch/seed graft?

A

Just push them in! Otherwise, not secured

NOTE: Pope will use a punch biopsy one size bigger for the donor site than the recipient site so that it’s a snug fit.

40
Q

What are 4 components to post-operative care for skin grafts?

A

Antibiotic ointment and non-adherent dressing
Absorbent secondary layer
Splint or cast wound if over joint
Change dressing in 24-48 hours
-Wait 48hrs if you can to allow fibrin seal to strengthen

41
Q

Which is usually established faster, venous or arterial supply?

A

Arterial supply

42
Q

What 2 things are common to see in a skin graft?

A

Venous congestion

Edema (lymphatics are a little confused)

43
Q

What are the 3 ways that vessels heal in a skin graft?

A

Plasmatic imbibition
Inosculation
Vessels grow completely up into dermis

44
Q

What is plasmatic imbibition?

A

Absorption of plasma and tissue gains nutrients that way

45
Q

What is inosculation?

A

Two blood vessels (one in donor site, and one in recipient site) gain direct contact

46
Q

What can over growth of normal superficial bacteria cause?

A

Superficial loss of epidermis

NOTE: This is NOT an infection

47
Q

If not black and dry or white and slimy, skin graft should be…

A

OK!

NOTE: Skin does have layers, don’t decide the graft has failed too quickly, epidermis may slough leaving normal intact dermis behind.

48
Q

What is a good principal to always remember with wound management?

A

KISS

Keep It Simple Sweetheart

Small Animal Surgery (13 decks)

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