Physical Examination for Surgeons: Examination of flaps and grafts

Checklist WIPER Physiological parameters General • Note any scars, deformities or skin lesions. Offer to inspect the whole body. Inspection • Identify any flaps and grafts, and describe any scars present (see Chapter 40, Examination of scars ). • Comment on the location. • Flap: • site and size • type of flap: local, regional or distant • phase of healing: well-healed, immaturity of scar, adequacy of outcome • check donor sites or exposure scars • Graft: • site, size and colour match of graft • type of graft: – pattern of scarring: split-thickness skin graft (STSG) or full-thickness skin graft (FTSG) – cobblestone or crocodile skin appearance (derived from a meshed graft) • healing: graft take as a percentage • bed of flap: muscle flap/native muscle/fat • Check common graft donor sites: • upper thighs for STSG • inner upper arms, supraclavicular fossa, retroauricular, groins for FTSG Palpation • Consistency: thickness, pliability, contour • Vascular supply: colour, capillary refill • Neurology: sensation • Base: • firm (recurrent disease or scarring) • fluctuant (seroma or haematoma) To complete the examination … • Inspect for donor sites and any other scars/skin lesions. • Offer to palpate regional lymphatic drainage sites if previous cancer excisions. Examination notes What is the system for inspecting flaps and grafts? S-T-H-D: S ite T ype H ealing D onor site What is the difference between a flap and graft? • A skin graft consists of skin tissue taken from one area of the body and transferred to another, being dependent on the recipient site for blood and nutrients. • A flap consists of tissue taken from one area of the body and transferred to another, bringing with it its own source of blood and nutrients. What are the different types of grafts? Split-thickness skin graft (STSG) • Split-thickness skin grafts consist of epidermis and a variable amount of dermis. • STSGs are able to resurface larger areas than full-thickness grafts.