General Surgery

💡 ### **Phases of Split Thickness Skin Graft Take** 1. **Plasmatic Circulation (Serum Imbibition)** - **Timeframe**: First **48 hours**. - **Process**: Nourishment of the graft through **plasma exudates** from host bed capillaries. 2. **Revascularization** - **Timeframe**: Begins after **48 hours**. - **Processes**: - **Neovascularization**: Blood vessels grow from the **recipient bed** into the graft. - **Inoculation**: Formation of **anastomoses** between graft and host vessels. 3. **Organization** - **Timeframe**: Begins **immediately after grafting**. - **Process**: - Formation of a **fibrin layer** at the graft-bed interface, holding the graft in place. - By **day 7**, **fibroblasts** replace the fibrin. - By **days 10 to 14**, the graft becomes **fully adherent** to the bed. --- ### **Key Concepts in Skin Graft Management** - **Revascularization (Option A)**: Starts after **48 hours**, with neovascularization and inoculation ensuring blood supply to the graft. - **Sensibility Return (Option B)**: **Re-innervation** begins at **4 to 5 weeks**, with **pain returning first**, followed by **light touch and temperature** over **12 to 24 months**. - **Graft Failure Causes (Option C)**: - The most common cause is **hematoma** under the graft. - Other causes: **Infection**, poor **recipient bed quality**, and donor site characteristics like **thickness or vascularity**. - **Dressings (Option D)**: - **Pressure dressing** minimizes **fluid accumulation**. - **Bolster or tie-over dressing** improves graft adherence and survival. - **Negative pressure wound therapy** is useful for **larger wounds** and stabilizing the graft on **irregular 3D surfaces**. This summary covers the critical aspects of **skin graft take**, failure, and management strategies for revision purposes.