problem wounds, flaps and grafts. wound care priorities 4 discover and treat injuries to critical...
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![Page 1: Problem Wounds, Flaps and Grafts. Wound care priorities 4 Discover and treat injuries to critical deep structures 4 Cover critical deep structures with](https://reader035.vdocuments.net/reader035/viewer/2022081512/56649c9c5503460f9495a380/html5/thumbnails/1.jpg)
Problem Wounds, Flaps and Grafts
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Wound care priorities
Discover and treat injuries to critical deep structures
Cover critical deep structures with skin Prevent infection, suture only when necessary Maintain function unhindered by contracture Cosmesis is a distant fifth priority
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Problem Closures
Important tissues deep to wound must be explored
Wound contaminated or skin nonviable Closure under tension or inadequate skin to
close Edges uneven or complex shapes
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Extend wound for exploration, parallel to important deep structures
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Problem Closures
Important tissues deep to wound must be explored
Wound contaminated or skin nonviable Closure under tension or inadequate skin to
close Edges uneven or complex shapes
![Page 6: Problem Wounds, Flaps and Grafts. Wound care priorities 4 Discover and treat injuries to critical deep structures 4 Cover critical deep structures with](https://reader035.vdocuments.net/reader035/viewer/2022081512/56649c9c5503460f9495a380/html5/thumbnails/6.jpg)
Debride contaminated sub Q fat and nonviable skin
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Debride and undermine to give everted closure
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Defatting flaps improves viability
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Apical stitch salvages viability
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V-Y closure for nonviable edge
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Closing a nonviable flap
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Problem Closures
Important tissues deep to wound must be explored
Wound contaminated or skin nonviable Closure under tension or inadequate skin
to close Edges uneven or complex shapes
![Page 13: Problem Wounds, Flaps and Grafts. Wound care priorities 4 Discover and treat injuries to critical deep structures 4 Cover critical deep structures with](https://reader035.vdocuments.net/reader035/viewer/2022081512/56649c9c5503460f9495a380/html5/thumbnails/13.jpg)
Undermining first choice to relieve tension, but leaves dead space
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Closing dead space prevents fluid collection but adds foreign body
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Cotton pledgets may help when you must close under tension
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Closing circular defect
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V-Y double advancement flap
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Curvilinear flap
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Z-plasty changes direction of wound to align with skin tension; use 60 degree angles
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Donor sites for full thickness grafts
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Measure site and prepare graft
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Hold the graft down to the bed
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Preferred method to bolster graft in place
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Problem Closures
Important tissues deep to wound must be explored
Wound contaminated or skin nonviable Closure under tension or inadequate skin to
close Edges uneven or complex shapes
![Page 25: Problem Wounds, Flaps and Grafts. Wound care priorities 4 Discover and treat injuries to critical deep structures 4 Cover critical deep structures with](https://reader035.vdocuments.net/reader035/viewer/2022081512/56649c9c5503460f9495a380/html5/thumbnails/25.jpg)
Avulsion closure: larger bite on flap side prevents override
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Use apical stitches first on geographic lacerations
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Apical first for stellate lacerations too
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Half buried horizontal for edges of differing thickness
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Fixing Bowser
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Closing parallel lacerations; where ample skin, could also simply excise island
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Dermal suture to close laceration within abrasion
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Moist occlusive dressing leads to more rapid healing of open wounds