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Surgery

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General Surgery

Question
99 out of 142
 

Thiersch graft is:



A Partial thickness
B Muscle flap

C Pedicle graft
D Full thickness

Ans. A Partial thickness (REF. SCHWARTZ SURGERY 8TH EDITION PG 1785-1799)

a. Skin grafts are mainstays for reconstruction of superficial defects or adjuncts to more complex reconstructions.

b. The type of skin graft is based on the thickness of the graft taken. The term "graft" is used to denote the fact that during harvest of the skin graft, all the vessels nourishing the graft are cut.

c. This is in contradistinction to the term "flap" which implies that some aspect of the blood supply to the segment of tissue has remained intact during transfer.

d. As such, the graft itself is the donor tissue; the wound bed to which it is applied is known as the recipient site.

e. A split-thickness graft requires that a portion of the dermis be taken along with the epidermis.

f. A full-thickness graft is one in which the full portion of the dermis is taken with the superficial epidermis .

g. The grafts will survive transfer based on a defined sequence of events that culminates in vascular independence. These events are

i. Serum imbibition—direct absorption of nutrients from recipient capillary beds that generally takes place in the first 24 hours;

ii. Inosculationthe connecting of donor and recipient vessels that typically begins in the 24- to 72-hour period; and

iii. Angiogenesis—vascular ingrowth of vessels from the recipient bed into the graft that starts after 72 hours. Factors that interrupt this process—such as fluid collection under the graft or mechanical shear forces—will compromise the graft take.

Split-Thickness vs. Full-Thickness Skin Grafts

Split-Thickness Graft

Full-Thickness Graft

Reliable take

+

Available donor sites

+

Primary contracture

+

Secondary contracture

+

Mechanical durability

+

Ability to grow hair, secrete sweat and sebum

+

Pigmentary changes

+

h. Thicker grafts have more difficulty with definitive adherence and survival because of the greater demand on vascular ingrowth.

i. However, the greater the proportion of dermis the graft has, the greater the inhibition of the myofibroblasts that cause secondary contraction.

j. The full-thickness skin graft can also retain functional hair follicles and sweat glands.

k. Split-thickness skin grafts are taken from sites depending on the thickness, color, and quality of skin needed.

l. The split-thickness grafts can be meshed in varying ratios to expand the potential coverage area.

m. If allowed to heal uninterrupted, the donor site 12/1000-inch skin graft can re-epithelialize in 7 to 14 days.

General Surgery Flashcard List

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