bolster dressing indicatins
aka tie over
- mobile or convex areas e.g. face, scalp.
- irregular or uneven surface
- areas difficult to dress e.g. nose, ear, perineum, axilla.
- hematoma or seroma formation is likely
Advantages of full thicknees sg
- better color/texture match,
- minimal secondary contraction
Disadvantages of full thickness SG
- limited size,
- donor site needs closure
Split/Partial Thickness Skin Graft advantages
covers large areas
Split/Partial Thickness Skin Graft disadvantages
- more secondary contraction
- poorer
cosmetic result
partial thickness tools
- humby knife
- power dermatome
- mesher
phases of wound healing in graft
- 24 - 48 hrs = plasmatic imbibition
- 48 - 72 hrs = inosculation
- 72h-7d = revascularization
Skin graft indications
- Cover large wounds where
primary closure is not possible - Burns (deep second or third degree)
- Traumatic skin loss
- After excision of tumors or chronic
ulcers - Post-infection defects (necrotizing fasciitis, etc.)
Contraindications of skin graft
- Poor vascular bed (exposed
bone/tendon without
periosteum/paratenon) - Active infection or contaminated
wound - Irradiated or ischemic tissue
no bed no blood just bugs
Requirements for Graft Survival
- Healthy, well-vascularized
bed - Good contact between
graft and bed (no
hematoma/seroma) - Immobilization (secure
dressing) - Aseptic technique
healthy, clean, touching but no moving
Complications of skin grafting
- Partial or total graft loss (due to infection, hematoma,
movement ,poor bed etc) - Contracture (especially with STSG)
- Poor color/texture match
- Donor site complications (pain, infection, delayed
healing..)
Flap Indications include:
- Coverage of exposed vital structures
- Need for functional reconstruction
- Need for aesthetic reconstruction
- Coverage of poorly vascularized or irradiated beds
- Dead space obliteration Pressure sores, trauma cavities, or after tumor excision
Flap Complications
Vascular
* Venous congestion (most common) → bluish, swollen flap
* Arterial insufficiency → pale, cold, no capillary refill
* Partial or total flap necrosis
…
Infection, hematoma and seroma
…
Donor Site Morbidity
* Scarring,
* contour deformity,
* loss of function,
* delayed healing
…
Functional or Aesthetic Problems
* Bulky flap,
* color/texture mismatch.
