Nurses understand the importance of ensuring that we do all we can to promote the successful outcomes for our patients who have skin grafts and skin flaps.Wound care has been a core function of Nursing for centuries and remains both challenging and also rewarding. Whilst workplaces provide access to Nursing Education and Nursing resources I thought you may like to check out this review Support Surfaces for Skin Grafts and Flaps: A Scoping Review. It ‘s enclosed for your reference.
The article, whilst American in origin has some really pertinent Nursing Care strategies and Nursing related information to assist with caring for patients.
The article provides a clear and simple overview of what skin grafts are including split – thickness grafts along with Fasciocutaneous Flaps, Musculocutaneous Flaps and Perforator-based Flaps.
Discussion is held regarding the common complications associated with Skin Grafts/ Flaps including “Wound Dehiscence ( 9.7-11%) followed by Necrosis ( 5.1-9.0%) and infection (4.8-7.5%). Individuals are more susceptible to complications with the following risk factors: multiple medical co-morbidities, cancer, advanced age, obesity, poor nutritional status, smoking, previous scarring, chronic use of steroids and prolonged operative time”[i]
Nurses did you know that “hydrofiber and silicone dressings may be associated with less pain and easier use”. The article identifies that if “the reconstructed areas is immobilised for between 2 – 8 weeks there is a better rate of graft / flap survival”.
Interestingly the article does make mention of Negative pressure wound therapies having been considered of use for immobilising grafts/ flaps, reducing oedema, removing excess drainage and stimulating angiogenesis, noting that the role that “atraumatic dressing and topical negative pressure play in graft/flap survival remains unclear”.
The article is great for Nursing education regarding the differences between low air loss and high air loss mattresses. This practical information is very useful when Nurses are determining the best choice of support mattresses (based on what is available) at your workplace for each patient. The article highlights how the surfaces ability to regulate microclimate can be simply compromised by how many layers of linen are placed on top of these surfaces.
Nurses you will be interested to know that “ turning patients every four hours when support surfaces are used is as effective in preventing pressure ulcers as turning patients more frequently without a support surface”.
If your workplace is still using standard hospital beds and foam based mattresses – you will find this article of interest as the deficits associated with same in regards to pressure are identified.
The Nurses for Nurses Network has a great range of Nursing Education and Nursing activities related to wound care. The sessions are focused on Nurses who need to know about managing wound care in the ‘real world’ where Nurses are often time poor and resource limited