II Lecture Chapter 19 Short Answer: Skin Procedures pp 412
Why would the STSG be "meshed"? How is this performed?
A mesh graft device is often used in conjunction with a split-thickness skin graft to expand the size of the skin that has been procured. The device is a manually operated roller with sharp raised surfaces that create evenly spaced splits in the graft. The harvested skin is placed on a plastic sheet called a derma-carrier prior to insertion in the mesh graft device. The purpose of the derma-carrier is to keep the graft flat and allow it to pass through the mesh graft device.
List two possible power sources for the oscillating-blade type dermatome.
Electricity or nitrogen
Once the FTSG is removed from the site, the surgeon flips the graft over; what will the surgeon do and why?
If necessary, to decrease tension on the wound edges, the subcutaneous tissue immediately surrounding the incision may be undermined using Metzenbaum or tenotomy scissors.
When taking a split-thickness skin graft (STSG) from the donor site, how is the donor site prepared?
STSG involves removing the epidermis and approximately half of the dermis for relocation to another part of the body. The STSG donor site is dressed and allowed to heal because epithelium growth occurs due to the dermis that is left in place.
Which tissue layer(s) is (are) affected by a second degree burn
The dermis
Describe the dressing for the FTSG that is sutured in place. Why is movement of any skin graft dressing detrimental regarding the "taking" of the graft" (capillary ingrowth)?
The newly applied skin will receive its blood supply from the capillary ingrowth from the recipient site; any disruption may cause the graft to be shed (sloughed off); therefore, careful placement of the dressing is important.
Use the rule of nines to determine the percentage of the body surface area affected by a third degree burn of the chest, back, and left arm
40.5%
Once the scar is excised, there are several techniques that can be used for the revision. Identify the types of revisions. Describe how the most common type is completed.
For thicker and/or longer scars, a Z-plasty scar revision procedure is one of the most commonly performed. A simple scar revision involves the surgeon using Adson tissue forceps with teeth to grab the end of the scar, slightly elevate and use a #15 knife blade to cut underneath the length of the scar, and perform a plastic/primary closure of the skin edges.
Prior to beginning the case, the surgeon completes the surgical prep of the recipient site using a scrub brush and preparing the bed for the graft. He is very happy to see it bleeding and no purulent discharge. Why?
I & D is the removal of foreign bodies or necrotic and infected tissue from the wound. This prepares the wound bed to accept the graft. Minimal capillary bleeding is desirable because it shows viability of the underlying tissue.
Analyze the setup for a skin graft. Why would it be necessary to change gloves during the procedure and segregate instruments as a clean and dirty setup?
If the recipient site is an open wound, two separate areas must be created on the sterile field and the instrumentation and supplies for each part of the procedure must be segregated to prevent contamination of the donor site or "seeding" of cancer cells to donor site.
Why is the excised tissue of a suspected carcinoma (basal cell carcinoma, squamous cell carcinoma, or leanoma) sent to pathology prior to the skin graft application?
If the specimen is considered a malignant lesion it is immediately sent to the pathology lab to be examined for margins to ascertain that all of the malignant tissue has been excised, along with a "buffer" of normal tissue.
Once the skin graft, either an STSG or an FTSG is taken, how is it preserved until needed for the site?
It must be kept on the derma-carrier to keep the graft from rolling up and kept moist by placing a saline-soaked sponge over the graft. If more than one graft is taken and meshed, each graft should be placed on a new derma-carrier.
