Plastic and reconstructive surgery, skin graft flaps, complications, preparation of patient for constructive surgery, postoperative care and health education
Time: 15:00
What is the most critical physiological difference between a skin graft and a skin flap?
[a] A graft is thicker than a flap.
[b] A graft is used for larger defects than a flap.
[c] A flap has its own intact blood supply, while a graft does not.
[d] A flap is taken from a donor, while a graft is from the patient's own body.
A nurse is performing a postoperative assessment on a patient with a new microvascular free flap on the lower leg. Which finding requires immediate notification of the surgeon?
[a] The flap is warm to the touch and pink in color.
[b] Serosanguineous drainage is present in the drain.
[c] The patient reports a pain level of 3 out of 10.
[d] The flap appears cool, pale, and has a capillary refill of >5 seconds.
Which preoperative patient factor is most critical to assess and address for a patient scheduled for flap surgery due to its significant impact on microvascular circulation?
[a] History of seasonal allergies.
[b] Level of daily fluid intake.
[c] Current smoking status.
[d] Preference for a specific type of diet.
A surgeon harvests a thin layer of epidermis and a portion of the dermis from a patient's thigh to cover a burn wound. This type of graft is known as a:
[a] Full-thickness skin graft (FTSG).
[b] Split-thickness skin graft (STSG).
[c] Composite graft.
[d] Dermal-fat graft.
The primary goal of a "tie-over bolster dressing" placed over a new skin graft is to:
[a] Absorb large amounts of wound exudate.
[b] Allow for easy inspection of the graft site.
[c] Keep the graft warm and promote vasodilation.
[d] Immobilize the graft and provide gentle, even pressure.
A patient who received a skin graft from a cadaver is said to have received which type of graft?
[a] Autograft.
[b] Allograft.
[c] Isograft.
[d] Xenograft.
A postoperative complication where a collection of blood forms under a skin flap, compromising its viability, is known as a:
[a] Seroma.
[b] Abscess.
[c] Hematoma.
[d] Dehiscence.
In postoperative care for a skin graft on the leg, what is the most important nursing intervention to promote graft "take"?
[a] Encouraging early and frequent ambulation.
[b] Applying warm compresses to the graft site.
[c] Immobilizing and elevating the affected limb.
[d] Performing active range-of-motion exercises.
Which type of reconstructive surgery involves placing a silicone balloon expander under the skin and gradually inflating it to generate new skin for future use?
[a] Serial excision.
[b] Z-plasty.
[c] Tissue expansion.
[d] Dermabrasion.
A nurse is monitoring a pedicled flap that appears swollen, tense, and bluish. This clinical presentation is highly indicative of:
[a] Arterial insufficiency.
[b] Venous congestion.
[c] A normal healing process.
[d] Infection.
Which health education point is most crucial for a patient being discharged after receiving a skin graft?
[a] The grafted skin will have normal sensation immediately.
[b] It is safe to use fragrant lotions on the new skin right away.
[c] The grafted area must be protected from sun exposure to prevent hyperpigmentation.
[d] The color and texture of the graft will match the surrounding skin perfectly.
The care of a split-thickness skin graft donor site is similar to the care of a:
[a] Deep surgical incision.
[b] Third-degree burn.
[c] Partial-thickness burn or a deep abrasion.
[d] Pressure ulcer with exposed bone.
A key component of the preoperative preparation for a patient undergoing major reconstructive surgery is ensuring optimal:
[a] Car-tanned skin.
[b] Hydration status.
[c] Nutritional status, particularly adequate protein levels.
[d] Knowledge of the hospital's visiting hours.
What is the primary advantage of using a full-thickness skin graft (FTSG) compared to a split-thickness skin graft (STSG)?
[a] The donor site heals more quickly.
[b] It can be used to cover very large surface areas.
[c] It provides a better cosmetic result with less long-term contraction.
[d] The graft "take" rate is significantly higher.
A TRAM (Transverse Rectus Abdominis Myocutaneous) flap is a type of reconstructive surgery commonly used for:
[a] Facial reconstruction after trauma.
[b] Breast reconstruction after mastectomy.
[c] Covering pressure sores on the sacrum.
[d] Hand reconstruction after a burn.
Which assessment tool is commonly used at the bedside by nurses to assess the patency of the microvascular anastomosis in a free flap?
[a] A stethoscope.
[b] A pulse oximeter.
[c] A handheld Doppler ultrasound device.
[d] A reflex hammer.
Reconstructive surgery, as opposed to cosmetic surgery, is primarily performed to:
[a] Improve a patient's self-esteem.
[b] Enhance normal physical features.
[c] Restore function and normal appearance after trauma, disease, or congenital defects.
[d] Reverse the natural aging process.
The first phase of skin graft healing, where the graft adheres to the wound bed and absorbs nutrients via capillary action, is called:
[a] Revascularization.
[b] Inosculation.
[c] Contraction.
[d] Imbibition.
Postoperative health education for a patient who had a cleft lip repair as an infant includes emphasizing the importance of:
[a] Avoiding all dairy products.
[b] Keeping the lip completely dry at all times.
[c] Protecting the suture line from tension or trauma.
[d] Encouraging vigorous crying to exercise the facial muscles.
A patient is scheduled for a Z-plasty procedure on a scar. The nurse understands that the main goal of this type of local flap is to:
[a] Completely remove the scar tissue.
[b] Add bulk to a depressed scar.
[c] Lengthen the scar and change its direction to reduce contracture.
[d] Transfer skin from a distant part of the body.
Which postoperative order should the nurse question for a patient with a new microvascular free flap on the arm?
[a] Elevate arm on two pillows.
[b] Check flap every hour with Doppler.
[c] Administer IV heparin infusion as prescribed.
[d] Apply a cooling blanket to the patient.
For a skin graft to be successful, the recipient wound bed must be:
[a] Completely dry and avascular.
[b] Covered with thick, dry eschar.
[c] Clean, well-vascularized, and free from infection.
[d] Exposed to the air for at least 24 hours before grafting.
Health education for a patient after flap surgery should include advising them to avoid which of the following to prevent compromising blood flow?
[a] High-protein foods.
[b] Gentle range-of-motion exercises.
[c] Constrictive clothing and caffeine.
[d] Adequate fluid intake.
A common postoperative intervention to prevent contractures in a patient with a new skin graft over a joint (e.g., the axilla or hand) is:
[a] Massaging the graft site vigorously.
[b] Maintaining the joint in a flexed position for comfort.
[c] Using splints to maintain a functional position.
[d] Applying elastic bandages tightly around the joint.
When is the first postoperative dressing change for a standard, uncomplicated skin graft typically performed by the surgical team?
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