Grafts

Discuss the stages involved in the survival of a split thickness graft.

What are the pros and cons of split vs. full thickness grafts?

How are skin grafts (full and split thickness) harvested? What is the point of meshing?

What is the best way to dress a wound? Is negative pressure dressing better than a bolster?

Reference(s):

Azzopardi, E. A., Boyce, D. E., Dickson, W. A., Azzopardi, E., Laing, J. H. E., Whitaker, I. S., & Shokrollahi, K. (2013). Application of topical negative pressure (vacuum-assisted closure) to split-thickness skin grafts: a structured evidence-based review. Annals of Plastic Surgery, 70(1), 23–29.

How will you manage the donor site in a split thickness graft? Is there an ideal dressing?

Reference(s):

Voineskos, S. H., Ayeni, O. A., McKnight, L., & Thoma, A. (2009). Systematic review of skin graft donor-site dressings. Plastic and Reconstructive Surgery, 124(1), 298–306.

Your split thickness skin graft has <20% take. List etiologies of skin graft failure and how to prevent them.

Reference(s):

Unal, S., Ersoz, G., Demirkan, F., Arslan, E., Tutuncu, N., & Sari, A. (2005). Analysis of skin-graft loss due to infection: infection-related graft loss. Annals of Plastic Surgery, 55(1), 102–106.

How does one harvest, process and store fat for grafting? Does technique affect viability?

Reference(s):

Gir, P, Brown, S.A., Oni, G., Kashefi, N, et al. (2012). Fat grafting: evidence-based review on autologous fat harvesting, processing, reinjection, and storage. Plast Reconstr Surg, 130(1):248-58.

Cheriyan, T, Kao, H.K., Qiao, X, Guo, L. (2014). Low harvest pressure enhances autologous fat graft viability. Plast Reconstr Surg, 133(6), 1365-8.

What are the nuances of fat injection?

What are Human Adipose Stem Cells?

Reference(s):

Gir, P., Oni, G., Brown, S. A., Mojallal, A., & Rohrich, R. J. (2012). Human adipose stem cells: current clinical applications. Plastic and Reconstructive Surgery, 129(6), 1277–1290.

Review osteogenesis, osteoconduction, or osteoinduction.

What are common donor sites for bone graft? List advantages and disadvantages for each.

What bone graft resorbs the most? How can you prevent this?

Tell us about three-dimensional (3D) computerized modeling.

Reference(s):

Kontio, R. (2014). Update on mandibular reconstruction: computer-aided design, imaging, stem cells and future applications. Curr Opin Otolaryngol Head Neck Surg, 22(4), 307-15.

You are asked to evaluate a trauma patient with a large cranial defect. What are the options?

Reference(s):

Dinopoulos, H., Dimitriou, R., & Giannoudis, P. V. (2012). Bone graft substitutes: What are the options? The Surgeon : Journal of the Royal Colleges of Surgeons of Edinburgh and Ireland, 10(4), 230–239.

What is an autograft, allograft, xenograft, homograft? What are the advantages and disadvantages? List common uses in the H&N.

Why does costal cartilage warp?

Reference(s):

Farkas, J. P., Lee, M. R., Lakianhi, C., & Rohrich, R. J. (2013). Effects of carving plane, level of harvest, and oppositional suturing techniques  on costal cartilage warping. Plastic and Reconstructive Surgery, 132(2), 319–325.