What You Should Know About Skin Grafts And Skin Substitutes

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    “You may be tempted to ‘double up’ a leftover graft on smaller wounds but it has not been shown to be beneficial so far, probably for the same reason that doubling up a partial-thickness skin graft does not really help in wound healing,” adds Dr. Suzuki.    Dr. Satterfield monitors autografts for infection and seroma, calling those the “biggest potential problems.” She suggests placing VAC therapy on the surface of the fenestrated autograft after one has stapled the autograft in place. As she notes, VAC therapy will increase the percentage of “take” and the time required for it to happen.    For Dr. Bell, post-op care depends primarily upon the location and etiology of the ulcer. For a diabetic foot ulcer on an ambulatory patient, he says strict offloading is critical. His practice uses total contact casting, soft casting and pre-screening for patient comprehension and adherence to keep the graft/ulcer protected at all times. In addition, Dr. Bell says venous leg ulcers typically require some type of compression dressing to assist in managing edema.    Between dressing changes, Dr. Bell notes one should perform gentle irrigation with normal saline and periodically change the primary dressing (Mepitel, Vaseline gauze). He notes the timing of this depends on the degree of drainage. He does not use silver dressings or other potentially cytotoxic compounds on grafts of any kind.    Dr. Bell is a board certified wound specialist of the American Academy of Wound Management and a Fellow of the American College of Certified Wound Specialists. He is the founder of the “Save a Leg, Save a Life” Foundation, a multidisciplinary, non-profit organization dedicated to the reduction of lower extremity amputations and improving wound healing outcomes.    Dr. Lullove is in private practice in Boca Raton and Delray Beach, Fla. He is a staff physician at West Boca Medical Center in Boca Raton. Dr. Lullove is a Fellow of the American College of Certified Wound Specialists.    Dr. Satterfield is an Associate Professor at the Western University College of Podiatric Medicine in Pomona, Calif. She is a Fellow and President-Elect of the American College of Foot and Ankle Orthopedics and Medicine.    Dr. Suzuki is the Medical Director of Tower Wound Care Center at the Cedars-Sinai Medical Towers. He is also on the medical staff of the Cedars-Sinai Medical Center in Los Angeles and is a Visiting Professor at the Tokyo Medical and Dental University in Tokyo, Japan.

References:


1. Margolis DJ, Allen-Taylor L, Hoffstad O, Berlin JA. Diabetic neuropathic foot ulcers: the association of wound size, wound duration, and wound grade on healing. Diabetes Care. 2002; 25(10):1835-9.
2. Snyder RJ, Kirsner RS, Warriner RA 3rd, Lavery LA, Hanft JR, Sheehan P. Consensus recommendations on advancing the standard of care for treating neuropathic foot ulcers in patients with diabetes. Ostomy Wound Manage. 2010; 56(4 Suppl):S1-24.

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