Date post: | 21-Nov-2014 |
Category: |
Health & Medicine |
Upload: | thangamani-ramalingam |
View: | 3,657 times |
Download: | 7 times |
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