Graft Revascularization and Healing Process

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What is the primary function of the fibrin network in the early stages of graft revascularization?

To prevent the formation of anastomoses.

To act as a scaffolding for capillary growth. (correct)

To serve as a barrier against infection.

To directly provide nutrients to the graft.

The formation of anastomoses between graft and recipient site vessels promotes capillary bud proliferation in the recipient bed.

False (B)

Approximately how quickly does new capillary ingrowth occur in a graft?

0.5 mm/d

Marked vascular remodeling takes place in the graft as the result of random anastomoses of graft arteries with recipient bed ______ and vice versa.

veins Signup and view all the answers

Match the events with their approximate timing after graft placement:

Initial observation of revascularization = 48-72 hours Blood begins to flow in graft vasculature = Third or fourth day Normal blood flow velocity is reached = Fifth or sixth day Signup and view all the answers

What primary factor contributes to the better viability of split-thickness grafts compared to full-thickness grafts?

Greater capillary density in the exposed dermal plexus. (C) Signup and view all the answers

Split-thickness grafts are generally more durable and less susceptible to trauma compared to full-thickness grafts.

False (B) Signup and view all the answers

What is the advantage of using split-thickness grafts in cases where wound contraction causes problems, such as contracture deformity?

graft expansion Signup and view all the answers

The establishment of perfusion is hastened in split-thickness grafts because ingrowing vessels have less distance to ______.

traverse Signup and view all the answers

Match the characteristics with the corresponding type of skin graft:

Split-Thickness Graft = Thinner dermis, better viability, potential for graft expansion. Full-Thickness Graft = More durable, less susceptible to trauma, subdermal plexus. Signup and view all the answers

What is the primary purpose of using skin hooks, forceps, or stay sutures when cutting long skin grafts with a dermatome?

To grasp and tense the graft, making it easier to cut and remove cleanly. (B) Signup and view all the answers

A power-driven dermatome is typically the most cost-effective option for surgeons who only perform skin grafts occasionally.

False (B) Signup and view all the answers

Why do many surgeons prefer to overlap the skin graft slightly beyond the edges of the recipient defect?

to ensure complete coverage Signup and view all the answers

After graft harvest, it should be oriented on the recipient bed to match the direction of ______ of the surrounding skin.

hair growth Signup and view all the answers

Match the following donor site closure techniques with their descriptions:

Excision and Suturing = The donor site is completely removed, and the edges are stitched together for a better cosmetic appearance. Open Wound Dressing = The donor site is covered with a nonadherent dressing, antibiotic ointment, or petrolatum-impregnated gauze and allowed to heal openly. Signup and view all the answers

Why is it important for a wound to be visually free from evidence of infection before applying a skin graft?

To minimize the risk of graft failure due to an intense or chronic inflammatory process. (C) Signup and view all the answers

Grafts applied directly to tendons always fail due to the lack of vascularity.

False (B) Signup and view all the answers

What type of tissue lacking adequate vascularity will directly prevent engraftment of a graft?

Avascular fat Signup and view all the answers

According to the case series, successful acute grafting was reported following tumor resection in canine patients on the antebrachium or _________.

tarsometatarsus Signup and view all the answers

Match the tissue type with the reason it is unsuitable for skin grafting:

Heavily Irradiated Tissues = Lack of adequate blood supply due to radiation damage. Chronic Ulcers = Presence of an ongoing inflammatory process. Avascular Fat = Inherent absence of blood vessels. Stratified Squamous Epithelial Surfaces = Does not have adequate vascularity. Signup and view all the answers

What is a recommended alternative to acute grafting for an open wound before?

Thorough debridement, bandaging with daily dressing changes, and delayed grafting. (D) Signup and view all the answers

Clean abrasion wounds may be grafted acutely.

True (A) Signup and view all the answers

What should be used instead of grafts for wounds that lack sufficient vascularity to support a graft?

Vascular flaps Signup and view all the answers

What is applied to the graft site before placing a nonadherent dressing?

A very thin coating of antibiotic ointment (C) Signup and view all the answers

Skin staples are not an acceptable method of securing skin grafts to the recipient site.

False (B) Signup and view all the answers

What is the purpose of trimming a 2 to 3 mm margin from the free graft edge before suturing it to the wound edge?

expansion of mesh sites Signup and view all the answers

After the edges are sutured, the graft is further secured by placing simple interrupted sutures between the ______ in the graft.

slits Signup and view all the answers

Match the described features with the post-grafting time frame:

Mesh openings have healed by second intention and are contracting = Three weeks after grafting Full-thickness mesh graft is sutured with multiple simple interrupted sutures = Immediately after graft placement Healed mesh openings are now virtually indistinguishable and hair regrowth is beginning. = Three months after grafting Signup and view all the answers

What should be done if excess tension is encountered when closing the donor site?

Use tension-relieving techniques. (C) Signup and view all the answers

Excessive ointment on the dressing is beneficial as it keeps the graft moist and further promotes graft take.

False (B) Signup and view all the answers

After meshing, what should be paid attention to, before placing the graft?

direction of hair growth Signup and view all the answers

What is the primary purpose of the secondary layer in a skin graft bandage?

Absorption, cushioning, and mild compression. (A) Signup and view all the answers

Splints are typically required for a minimum of 21 days following a skin grafting procedure to ensure complete immobilization.

False (B) Signup and view all the answers

What solution is recommended for gently cleaning a superficial infection on a graft surface?

0.05% chlorhexidine solution in saline Signup and view all the answers

The tertiary outer layer of a skin graft bandage is designed to provide protection from the environment while remaining ______.

breathable Signup and view all the answers

Match each layer of a skin graft bandage with its primary function:

Contact Layer = Ensuring direct contact with the recipient bed Secondary Layer = Providing absorption, cushioning, and mild compression Tertiary Layer = Protecting from the environment while remaining breathable Signup and view all the answers

Which material is NOT recommended for the outer layer of a skin graft bandage?

Waterproof adhesive tape (B) Signup and view all the answers

Hyperbaric oxygen therapy (HBOT) consistently demonstrates improved graft viability and reduced inflammation in grafted wounds.

False (B) Signup and view all the answers

Besides a Mason metasplint, name one other method for immobilizing joints with grafts.

Schroeder-Thomas splint Signup and view all the answers

Graft Vascularization Timing

Graft vascularization typically starts between 48-72 hours post-placement.

Anastomosis

Anastomosis is the connection formed between graft vessels and recipient site vessels, promoting blood flow.

Capillary Bud Proliferation

The growth of capillary buds from the graft bed into the graft is inhibited by blood flow from anastomoses.