Therapy management of complex injuries of the hand. Rehabilitation of the Hand and Upper Extremity. Wound care and dressings. Clinical Nursing Skills. Hoboken, NJ: Pearson; chap Wysong A, Higgins S. Basic principles in flap reconstruction.
Flaps and Grafts in Dermatologic Surgery. Philadelphia, PA: Elsevier; chap 2. Editorial team. Skin flaps and grafts - self-care. A skin flap may contain skin and fat, or skin, fat, and muscle. Often, a skin flap is still attached to its original site at one end and remains connected to a blood vessel. Sometimes a flap is moved to a new site and the blood vessel is surgically reconnected.
This is called a free flap. Skin grafts are used to help more serious, larger and deeper wounds heal, including: Wounds that are too big to heal on their own Burns Skin loss from a serious skin infection Surgery for skin cancer Venous ulcers , pressure ulcers , or diabetic ulcers that do not heal After mastectomy or amputation The area from where skin is taken is called the donor site.
Donor sites for grafts and flaps are chosen based on: How closely the skin matches the area of the wound How visible the scar will be from the donor site How close the donor site is to the wound Often the donor site may be more painful after surgery than the wound due to newly exposed nerve endings.
Caring for Skin Flaps and Grafts. The dressing does several things, including: Protect your wound from germs and reduce the risk of infection Protect the area as it heals Soak up any fluids that leak from your wound To care for the graft or flap site: You may need to rest for several days after surgery as your wound heals.
The type of dressing you have depends on the type of wound and where it is. Keep the dressing and area around it clean and free from dirt or sweat. Do not let the dressing get wet. Do not touch the dressing. Leave it in place for as long as your doctor recommends about 4 to 7 days. Take any medicines or pain relievers as directed. If possible, try to elevate the wound so it is above your heart. This helps reduce swelling. You may need to do this while sitting or lying down.
You can use pillows to prop up the area. Typically, once the wound is thoroughly rinsed, I will use a non-stick dressing. A plain one is similar to Telfa. Some of the fancier ones will have Vaseline in them such as Vaseline gauze or Adaptic. Keeping Bacitracin on the wound will keep the dressing from sticking.
Another product that is sometimes used is a prescription cream or ointment called mupirocin. This covers a wide variety of bacteria and the ointment in available in a generic. Because the skin surrounding the wound is so very fragile and thin, it is wise to avoid any kind of tape or adhesive. To attach the dressing we use a wrap gauze like Kerlix. We also use stretch netting that comes in a variety of sizes to fit the extremity.
At home, the easiest thing to use is a long sock with the foot cut off. This will work perfectly to keep the dressing in place. It can be washed and reused. If tape or a bandage is applied that adheres to the skin it is very important that the tape not be just pulled off. For example, if you have an abrasion on your arm, hold it up while applying pressure to the wound. Clean the wound. When you have the bleeding under control, you need to clean the wound carefully and thoroughly to avoid any infections.
Start by rinsing around the wound with cool water to remove any debris. Be careful not to aggravate the wound and re-start the bleeding. Clean around the wound with saline if it is available. Using saline to clean the skin flap and wound area helps keep the skin supple and therefore makes it easier to reattach it to the wound border.
If you do not have saline, use soap and water, but be careful not to get any soap into the wound itself. For a minor wound you do not need to use hydrogen peroxide, iodine, or a similar cleanser. These products can irritate the injured tissue. Hydrogen peroxide should not be used on any open wound. You can carefully remove any remaining debris in the wound with tweezers.
Be sure to sterilise the tweezers first with rubbing alcohol. Determine whether or not to cut off a skin flap. If you have a skin flap, you need to determine whether or not to trim this off before you dress the wound.
A flap of skin appears when the skin layers have separated. There are two types of skin flap: full thickness and partial thickness. Full thickness flaps happen most often when the skin is thin and fragile, and are most common for older people. A partial thickness skin flap can occur on an area of thick skin, such as the palm. A partial thickness skin flap only involves losing the outer layer of your skin. You may be able to tell if it is a partial thickness flap by looking for fingerprint lines on the underside of the flap.
If you are in any doubt, treat it as a full thickness flap and get it treated by a doctor or nurse. Know if you should call a doctor. Before you continue and dress the wound, make yourself aware of the circumstances in which you should seek professional medical help.
If you have a minor cut or abrasion, this will not normally not be necessary. There are instances when a seemingly minor abrasion will require treatment. These include: If the skin is torn and you have skin flap. The wound is large, deep or gaping and may require stitches. It is a puncture wound, which may have been caused by standing on a nail or an animal bite.
There are signs of infection, such as pus, a bad smell, or you are feeling unwell. You are taking medication that may affect your healing. Part 2. Apply antibiotic ointment to the wound. When you are ready to dress the wound, you can begin by applying a thin layer of an antibiotic ointment or cream.
Some ingredients in antibiotic treatments can cause a rash to develop around the wound. If you experience discomfort and a rash appears, stop using the ointment or cream. Cover the wound. Now you can apply a dressing or covering over the wound. This will help you keep the wound clean and free from infection. Ensure that the dressing you apply is sterile, and take care not to irritate the wound as you apply it.
Again, use Telfa dressing if you have it. If your cut or abrasion is minor, you may not need to cover it. Change the dressing regularly.
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