Principle of Wound coverage Flap Surgery - AADO

Principle of Wo
an

Flap S

Tse
AADO. H
Nursing sy

ound coverage
nd
Surgery

WL
HKSSH
ymposium

Why Wounds nee

To av

• Infection : Acute or C
• Exposure of importan

vessels, tendon, bon
• Electrolyte loss
• Protein loss

ed to be covered ?

void :

Chronic
nt tissues : nerve,
ne, joint

Consequence
cove

• Uncontrolled sepsis –
• Extensive scarring –

functional deficit

• Ideally, wound cove
achieved within 1 w

of poor wound
erage

– life threatening
cosmetic and

erage should be
week after injury

Management of S

Primary Goal
(initial healing and

infection control)

• Skeletal stability
• Adequate blood

supply
• Soft tissue coverage

Severe limb injury

Secondary goal
(functional

reconstruction)

• Nerve repair/graft
• Muscle & tendon

repair/transfer
• Bone & Joint

reconstruction

Adverse Factors f

• Infection
• Retained foreign bodies
• Retained devitalized tiss
• Poor circulation
• Radiation or chemother
• Systemic factors : malnu

immunosuppression, m
PVD, smoking, obesity
• Wrong choice of treatm

for wound healing

s
sue

rapy
utrition,
medical diseases e.g DM,

ment

Patient pr

• Local :

– adequate debridement
– Dressing care : keep wou

barrier to infection

• Systemic :

– Nutritional support
– Antibiotics
– Pain control
– Stress relief

reparation

und clean and tissue viability,

Dress

• Debridement ( of non viable
tissue)

– e.g. Iroxol

• Decontamination ( of infective
agents)

– Seasorb silver (contain alginate
to trap water)

– Anticoat (silver only)
– Aquacel (hydrofiber)

• Promotion of healing

– Solcoseryl
– Actovergin
– Collagen

• External stimulation :

– Hyphecan

ssing

• Optimal Environment
• Local tissue circulation

Bacter

• All wounds are colonize
• Presence of bacteria ≠
• Established infection do

coverage surgery

– Except certain bacteria
– Streptococcus

• Streptolysin
• Clear thin exudate

– Pseudomonas

• Green colour exudate

riology

ed by bacteria
≠ infection

oes not preclude wound

Bacter

• Rational use of antib
• Nature of wounds
• Intelligent guess
• Avoid prolonged topi
• Surgical debridemen

tissues

riology

biotics

ical antibiotics
nt of dead and infected

Anat

• What structures are m

– Loss of major peripher

• What needs to be rep

– Cavity filling

• What tissues available

– Vascular anatomy

• What tissues available

– Free tissue transfer

• Overall vascular statu

tomy

missing

ral nerves

placed

e nearby

e distant

us of the limb

WOUND PRE

EPARATION









Topical Negative

e Pressure (VAC)

Vacuum Assi

isted Closure

VAC re

• Negative pressure

– Most wound : 125mmHg
– 50-125mmHg for skin gra

• Cycle :

– Constant for 48 hr then in

• Dressing changes

– Most wound : 48 hr then
– Infected : less than 48 hr
– Clean wound : 4-5 days

egime

g
afts

ntermittent (5minon/2min off)

every 4-5 days
r

Reconstruc

• Primary closure
• Secondary intention “wo
• Skin graft
• Flap

– Local
– Distant
– Free

• Select the simple
fulfill wound requ

ction ladder

ound contraction”

est method that
uirement

Skin

• Full thickness (includ
(~0.015 inches)

• Survive on vasculariz
“imbibrition”

• May achieve sensat
sensory nerve into th

graft

ding dermis) or splitted

zed bed by

tion by ingrowth of
he graft





SSG pre

eparation

Tie over

Dona

• Keep dressing intact x
2-3 weeks unless
infection is suspected

ar site

• Failed by poorly vasc
infection, shearing

• Bulky dressing, “Tie o
plaster immobilization

• For SSG : inspect aft

• Skin contracture, hyp

cularized bed,

over dressing”, VAC,
n
ter D5, FTSG : D7
perpigmentation

SS

SG

SSG vs

• SSG

– Depends on the vasculari
– Scars usually bad
– Good for large areas
– Donor sites can be used r

• FTSG

– Limited supply
– Good skin like quality
– Different mechanism of re
– Can be used on bare tend

s FTSG

ity of recipient bed
repeatedly

ecipient site incorporation
don or bone

FLA

AP