Plastic surgery & physiotherapy

Aims Wound closureTo prevent infectionTo recover skin function/reconsruct

DefinitionsGraft

A skin graft is a tissue of epidermis and varying amounts of dermis that is detached from its own blood supply and placed in a new area with a new blood supply.

FlapAny tissue used for reconstruction or wound closure that retains all or part of its original blood supply after the tissue has been moved to the recipient location.

Graft vs FlapGraft

Does not maintainoriginal blood supply.

FlapMaintains original

bloodsupply.

Reconstructive ladderFree flap

Distant flap

Local flapFull thickness

skin graft

Split graftPrimary closure

Secondary intention

Skin graft

Split thickness graft

Full thickness

skin graft(epidermis+dermi

s)

Composite graft(skin+sub.cut.tiss

ue)

Type of Graft Advantages Disadvantages

Thin Split Thickness

-Best Survival-Heals Rapidly

-Least resembles original skin.-Least resistance to trauma.-Poor Sensation-Maximal Secondary Contraction

Thick Split Thickness

-More qualities of normal skin.-Less Contraction-Looks better-Fair Sensation

-Lower graft survival-Slower healing.

Full Thickness

-Most resembles normal skin.-Minimal Secondary contraction-Resistant to trauma-Good Sensation-Aesthetically pleasing

-Poorest survival.-Donor site must be closed surgically.-Donor sites are limited.

Auto graft-no rejection

Homo graft-rejected in 3 weeks

Hetero graft

Skin culture

Meshed skin

Skin flap

Random pattern flapsub dermal plexus

Skin flap

Local flapstranspositional flap,rotation

flap,z plasty,

v/y plasty

Distant flapsgroin flap,cross leg

flap,pedicle flap

Free flapsblood vessels

dissected and

anastamosed to the

recipient area

Musculo/myo cutaneous flap

Harvesting ToolsRazor BladesGrafting Knives (Blair, Ferris, Smith, Humbly,

Goulian)Manual Drum Dermatomes (Padgett, Reese)**Electric/Air Powered Dermatomes (Brown,

Padgett, Hall)

Electric & Air Powered tools are most commonly used.

Padgett Dermatome

Goulian Blade

Donor Sites Color Thickness Hair Texture

Other plastic surgeriesTissue expansionNerve repairNerve graftingNerve transferNeurolysisTendon repairTendon graftTendon tranferTenolysisToe to hand transferReplantation

Hand burnsSubjective examinationObjective examination -observation/palpation edema assessment-tapes/rings/callipers&volumetric

measurementsScar assessment-photography,vancouer

scale(pigmentation,vascularity,pliability&height)CirculationNails/skinGoniometry/MMTGrip strength/hand held dynamometrySensation testing/pain/neurological tests

Physiotherapy

Education Wound careElevationActive exercisePassive movementsStretchingCPMNeural mobilizationMassageCompression

Pressure garmentsSilicon, coban SplintsThermal

modalities/US/TENS/PEME/NMES

Strengthening/endurance exercises

Motor/sensory re educationDesensitization Functional training/OT