Burns and Burn Injury Q 34

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What statement by the client indicates the need for further discussion regarding the outcome of skin grafting (allografting) procedures?

  

    A. “For the first few days after surgery, the donor sites will be painful.”

    B. “Because the graft is my own skin, there is no chance it won’t ‘take’.”

    C. “I will have some scarring in the area when the skin is removed for grafting.”

    D. “Once all grafting is completed, my risk for infection is the same as it was before I was burned.”

    

    

Correct Answer: B. “Because the graft is my own skin, there is no chance it won’t ‘take’.”

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Factors other than tissue type, such as circulation and infection, influence whether and how well a graft “takes.” The client should be prepared for the possibility that not all grafting procedures will be successful. Graft survival depends on the diffusion of nutrients and oxygen from the wound bed known as imbibition. Inosculation then follows when the blood vessels of the graft and from the wound bed grow together to make end-to-end contact. Lastly, neovascularization occurs when new blood vessels grow from the wound bed into the graft.

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Option A: The donor sites will be painful after the surgery. Silicone gel sheets, along with pressure dressings, have shown a dramatic decrease in pain, pruritus, and scar thickness six months after burn injury.

Option C: There can be scarring in the area where the skin is removed for grafting. Burn scars are a common occurrence after skin grafting and can cause anxiety, depression, pain, itching, altered pigmentation, temperature intolerance, and decreased range of motion secondary to scar contracture. Scar formation is propagated by deficiencies in the biosynthetic and tissue degradation pathway during wound healing.

Option D: The client is still at risk for infection. Early failure of graft survival is attributable to seroma and hematoma formation, which lifts the graft off the wound bed, preventing imbibition. Other factors that lead to graft failure include shearing forces, edematous tissue, and infected tissue.

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