Other warning signs of an infection or failed skin graft include, but are not limited to, continuous pain and fever. The main difference between skin grafts and skin flaps, as previously discussed, is that a skin flap is comprised of tissue, and sometimes muscle—these are known as muscle flaps—which has kept its blood supply intact, and been relocated to another area of the body.
Similar to skin grafts, skin flaps can originate from various parts of the body, depending on location and size of the recipient site. Therefore, it is eventually detached from the donor site once the surgeon performs the transplant. A free flap is similar to a distant flap, but is completely removed from the donor site prior to being transported to the recipient site.
Consequently, patients should keep the aforementioned list in mind. As noted, receiving HBOT before— and after —surgery as a way to prepare both the donor and recipient sites— and help encourage a faster recovery —is a key preparation tip.
Smoking, drinking, and taking certain medical drugs and other supplements, and putting on any skin care products are all typically prohibited. Comparable to skin graft patients, skin and muscle flap patients must make rest and keeping their wounds covered top priorities. Patients should also only take the prescribed medicine if applicable provided by their health care provider.
Persistent swelling and increased pain and irritation are indications that the patient may be suffering from an infection. As briefly mentioned, hyperbaric oxygen therapy, also referred to as HBOT, is a treatment that can be utilized both before and after skin graft and flap surgeries.
It can also be used to help patients who have undergone failed procedures to heal, or to stop the progression of some post-surgical complications that may ultimately lead to failure. HBOT nourishes the body with oxygen at increased atmospheric pressure. This treatment stimulates blood vessel growth, which in turn, increases circulation. Remember, proper circulation ensures enough oxygen, blood and nutrients are being transported throughout the body. At HMS, we want to share our enthusiasm and knowledge about this extraordinary technology's ability to help individuals in their healing and recovery process, creating life-changing results.
Call our office today at or click the button below to Get Started with Hyperbaric Oxygen Therapy and learn how it can help you accelerate healing and achieve optimal health! While studies support the effectiveness of hyperbaric oxygen therapy when used to help treat various medical conditions, individual results may vary.
Scrupulous surveillance of a graft includes serial inspection of both the donor site in autografts and the graft recipient site. Vascular compromise can be diagnosed by inspection for color change, diminished capillary refill, temperature, edema, and general appearance. Blood or transudate exudate, in the case of infection can be diagnosed via aspiration with a needle.
The retrieved contents are examined microscopically for red blood cells, white blood cells, and bacteria via a gram stain. The aspirate also can be cultured for sensitivity testing of any positive bacterial growth. Aspiration also allows the therapeutic benefit of reducing separation between the graft and the wound bed. If infection is suspected, diagnosis is via cultures from the graft site, retrieved to identify any infecting organism with subsequent testing for its sensitivities to several antibiotics.
The most common cause of graft failure is movement, which dissociates any new blood vessel growth neovascularization into the graft, depriving it of oxygen and nutrients. This complication causes fluid collection between the graft and the graft site bed hematoma or seroma , further separating the graft from the bed. Immobilization is accomplished by appropriately dressing the graft site. Any scar that is raised above skin level is considered hypertrophic. Such keloid formation is diagnosed via simple inspection.
Partial graft loss can be treated with wet or moist saline-soaked gauze or other local dressings. If salvaging the graft is successful to any extent, the defect can be allowed to heal secondarily filling in.
Re-grafting must take into consideration the reasons the first graft failed. Complete graft loss requires reassessment of the wound bed for blood supply.
If the bed is poorly vascularized, thinner grafts can be used which have less of a neovascularization demand. If the wound bed is well vascularized, re-grafting can be attempted with a thicker graft.
Choice of dressing is usually by physician preference, but the dressing should be non-adherent. Transparent plastic wound dressings allow inspection of the wound. They are generally atraumatic and can be be covered with silver nitrate or iodine soaks. Bandaged graft sites will become dry, therefore moisturizer should be applied at least daily after bandage removal. Immobilization of the graft prevents shearing of it and the resulting accumulation of hematoma or seroma fluid under it, the main contributor to neovascularization failure.
In autografts, the additional wound—the donor site—is evaluated every 3 days until healed. Preventing graft failure or compromise is by scrupulous surveillance to identify as early as possible the following:. Pre-graft, these complications can be prevented by proper wound bed preparation.
During the grafting, complications can be reduced with intraoperative meticulous hemostasis and careful placement of the graft. After the procedure, immobilization is used with appropriate dressing to prevent shearing during the healing period. This entails strict glycemic control for diabetics, smoking cessation, and correcting any protein or vitamin deficiencies. Medications that interfere with wound healing steroids, immunosuppressants, and anticoagulants should be discontinued temporarily.
In full-thickness skin grafts, the wound should be debrided where necessary and inspected for shearing or infection. Your doctor will perform a skin graft to replace the skin in an area where the skin has been severely damaged. The source sites most commonly used for skin grafts are the inner thigh, buttocks, below the collarbone, in front of and behind the ear, and the upper arm. An autograft is when you use your own skin as the source of the graft.
If there is not enough skin on the body to provide graft coverage, you may need skin from other sources. These sources are only meant for temporary use until your own skin grows back. Three common options are:. A successful skin graft will result in transplanted skin adhering and growing into the recipient area. If you are planning to have a skin graft, your doctor will review a list of possible complications, which may include:. Edits to original content made by Rector and Visitors of the University of Virginia.
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