COMPLEX INJURIES OF THE LOWER LIMB

SOFT TISSUE RECONSSTRUCTION

Soft tissue involves skin, subcutaneous tissue, muscles, nerves and arteries.

So, any tissue involved in injury should be replaced with like tissue.

A laceration can be repaired primarily, but if there is a defect or gap in the soft tissue which cannot be primarily closed can be reconstructed with different options like skin graft or flap coverage.

SKIN GRAFTING

Graft is a tissue of body taken from another part of body without its vascular supply and applied to cover the defect.

So, if there is a defect with skin loss only and underlying structures like tendons, nerves, arteries and bones are not exposed then simple skin graft can cover the defect.

PROCEDURE

Usually, it is done under general anesthesia. 

Skin is harvested with minimum thickness through special knife (Humby’s) from donor site like thighs, legs, arms etc. this donor site is then covered with adherent dressing like alginates.

The harvested skin is then applied over the healthy wound bed and secured with stitches or staples then covered with bulky non adherent dressing and splintage applied to avoid shearing due to movements.

POST-OPERATIVE MANAGEMENT

Patients are admitted for at least 3-5 days.

Dressing is changed at 3rd or 5th day post operatively and graft is checked for its take (adherence to wound) 

Then the patient is discharged home with regular follow up as an outpatient. Dressing is changed on a daily or alternate day basis depending upon the condition of the wound.

Skin graft heals in 10-14 days while donor site heals in 7-10 days.

Splintage is removed after graft heals and weight bearing, and physiotherapy started.

Patients are advised to take care of grafted skin by applying moisturizers and silicon gels to reduce shearing and untoward effects.

Skin graft take depends upon multiple factors like general health of patient, comorbid, local wound condition, infection, non-compliant patient, mobility of grafted area etc.

with nominal conditions success rate is 90-10

COMPLICATIONS

Graft loss

Pigmentation

Hypertrophic scarring

Contour abnormality.

 

Written by: Dr Ali Adnan

Copyrights: Pakistan association of Plastic Surgeons