Surgical Reconstruction in Difficult Wounds

You are planning to use autologous cartilage to reconstruct a major nasal wound. Which one of the following represents a caveat with cartilage grafting?

• It commonly becomes infected.

• It has a high chance of resorption.

• It is difficult to precisely sculpt.

• It has a tendency to warp.

• Donor site morbidity is high

A patient has a pressure sore on the left heel measuring 5 cm. It involves full thickness tissue loss to, but not through, fascia or bone. What stage is this sore?

• Stage I

• Stage II

• Stage III

• Stage IV

• Unstageable

You assess a patient with a nonhealing ulcer at the lower limb. Examination shows a 3 x 3 cm ulcer between the malleoli and gastrocnemius myotendinous junction. There is surrounding soft tissue firmness and swelling with pigmentation changes and varicosities. Which one of the following is the most appropriate management of this ulcer?

• Excision biopsy

• Referral for revascularization surgery

• Hyperbaric oxygen therapy

• Compression bandaging

• Negative pressure wound therapy

Which one of the following is correct when using a skin graft in the hand?

• Full-thickness grafts are best harvested from the contralateral upper limb.

• The heel is a good donor site for glabrous skin graft harvest.

• Split-thickness skin grafts should be meshed to improve graft take.

• It is normal for glabrous skin grafts to appear sloughy at 1 to 2 weeks.

• After harvest, split-thickness skin grafts contract immediately more than full-thickness grafts

A 60 years old diabetic woman presented with a large infected sacral wound due to pressure sore developed from complication of untreated hip bone fracture:

• Suitable for immediate soft tissue reconstruction

• Start a broad spectrum antibiotic and monitor progress

• Fix the bone fracture to off load the pressure

• Debride the infected sore until healthy tissue

• Nurse in intensive care unit for close monitoring of impending sepsis

Regarding split thickness skin graft:

• As a reconstructive option over a facial wound that unable to close primarily

• Suitable to be applied over an exposed bone wound

• Can be meshed to increase the area of coverage

• Have less secondary contraction compare to full thickness skin graft

• Allograft is a gold standard

You encounter a large wound exposing Achilles tendon:

• Wound bed preparation with foam dressing to optimize the wound condition

• Can be grafted if the paratenon is preserved

• For secondary healing with good granulation tissue

• Conservative management with wet to dry dressing is adequate

• Necrotic tendon can be left in situ

You encounter a large wound from an excision of marjolin ulcer with a positive margin at its base:

• Apply a VAC dressing to promote fast healing

• Take another tissue for HPE to confirm the diagnosis and direct the treatment

• Skin graft can help with quick recovery for radiotherapy anticipation

• Surgical re-excision is warranted for a clear margin

• Free flap is efficient in dealing with this kind of wound

You encounter a huge anterior chest wound post CABG exposing the sternal bone:

• For a conventional daily dressing to aim for secondary healing intention

• Do a split thickness skin graft

• Apply a Negative Pressure Wound Therapy

• Referral to Reconstructive Surgeon for Flap surgery

• Pack with Kaltostat dressing

Which one of the following is an advantage of using a cutaneous autograft?

• Reduced duration of surgery

• Good tolerance and incorporation

• Avoidance of a donor site

• Limitless tissue quantity