M and M

Sundip Patel, 1/7/2009

History

• 65 y/o male w/ h/o penile cancer s/p excision and inguinal lymph node dissection

• Post-op hematoma evac and wound vac placement

• Elective presentation for skin graft to right inguinal area

History

• Well nourished

• Diabetic

• No anticoagulants

Operation

• Skin graft harvested from Right thigh w/o problems

• Cut to appropriate size and sutured to right inguinal wound

Post Op

• Pt held 5 days of bedrest

• Moist to dry dressing over wound during this time

• Post – op day 5, skin graft seen as a ball not taken by wound bed

Operation 2

• Pt brought back following week

• New technique for split thickness skin graft– Debridement of wound bed– More sutures– Tisseal used– Vac dressing applied

Post - Op

• Bed rest for 3 days

• 2 weeks after operation, pt had great result of skin graft

RECS

• Wound preparation is the source of most skin graft failures

• Hx of radiated wound less optimal

• Underlying conditions that compromise wound healing, venous stasis, and arterial insufficiency should be optimized

RECS

• Wound Vac shown to increase granulation tissue and decrease bacterial count

• Wound preparation involves cleansing with saline, judicious debridement, and meticulous hemostasis

• Place slits to allow decrease fluid build-up

RECS

• 4-corner sutures are placed to hold the graft in the proper orientation. Then a running suture is placed around the periphery

• Place needle thru graft first, then thru skin