Plastic and Reconstructive Surgery
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What is plasmatic imbibition?
- Passive diffusion of nutrients from the recipient bed to the skin graft.
- Lasts for 24-48 hrs
What is inosculation?
- Process by which capillaries from the recipient bed align with capillaries from the graft
- Begins 48 hrs after graft placement and lasts 2-4 days
- The circulation initially is immature and prone to blood pooling and pendulum-like flow
When is the final stage of skin graft revascularization?
- 5-7 days after grafting
- Marked by formation of a mature circulation with afferent and efferent blood flow established
Describe the process of skin graft revascularization
The first 24-48hrs = Plasmatic imbibition --> then inosculation for 2-4 days --> then maturation 5-7 days after placement.
Revascularization occurs by both formation of anastamoses between recipient & graft vessels and by neovascularization
Arterial circulation returns before venous, which is why the newly grafted extremity should be elevated; also explains graft color change from pink to blue/purple due to venous congestion.
Describe Split Thickness vs Full Thickness skin grafts:
Split Thickness = contains epidermis & variable partial thicknesses of underlying dermis
Full Thickness = harvest at the dermal-subcutaneous junction
How long does it take a split-thickness skin graft donor site to be resurfaced with epithelial cells?
1-3 weeks depending on the depth
Describe primary contraction in full & split thickness grafts:
Primary contraction = immediate shrinkage of the surface area caused by recoil of the elastic fibers of the dermis
Full thickness shrink by ~40%, split thickness by ~10%
What is secondary contraction?
Caused by myofibroblasts in the bed of a granulating wound interacting with collagen fibers.
Greater in wounds covered with split thickness than full thickness grafts as the amount of contracture is inversely proportional to amount of dermis in the graft
When does sensation return to grafted areas?
Begins at 10 weeks and is maximal at 2 years (although may not be completely normal)
Define random flap:
Derives its blood supply from the dermal-subdermal plexus
Define axial flap:
Derives its blood supply from a direct, usually named cutaneous artery
When are random flaps used?
To reorient a wound in a different direction or to close a small defect.
Examples of random flaps:
- simple rotation flap
- advancement flap
- V-Y flap
- transposition flap
- rhomboid flap
- interpolation flap
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