tal (LTMGH), India, is presently a consultant general surgeon in Mumbai, India. Her areas of interest are burns, non-burn trauma and wounds, and venous diseases. An acknowledged teacher and sought-after speaker, Dr. Gore established the first cadaver skin bank in India. She is an avid researcher and has been the chief investigator for more than twenty-five national and international clinical trials. She has more than seventy-five publications in national and international journals to her credit and has contributed seventeen chapters to various books. She has been honored with several awards, prizes, scholarships, and orations for her contribution to the fields of her special interest.
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Contents
Preface Section 1 Wound Bed PreparationChapter 1
PrefaceWounds are common injuries that almost every human being experiences. They can vary in depth of tissue damage, etiology, location, contamination, lymphovascular integrity, and sensory neural function. They can be associated with diabetes, cardiovascular morbidity, hepatic and/or renal dysfunction, immunological status, malignancy, nutritional deficiencies, and so on. Wound healing is dependent on all these factors and many more.Wounds that are limited to the epidermis and superficial layers of the dermis generally close and heal naturally. We now know the stages in this process and understand the role of multiple mediators, growth factors, cellular contributions, and the interaction between these components. However, there is no method by which we can control or modify this natural process of wound healing.The situation is different when the wound involves full-thickness skin loss with or without loss of subcutaneous and deeper tissue. These wounds cannot achieve closure naturally, as both epidermal and dermal elements are lost. Without intervention, these wounds may remain as chronic, non-healing ulcers or they may close via wound contraction and formation of scar tissue causing functional limitations, deformities, and disfigurement. These scars may be unstable, leading to repeated breakdown, and are likely to develop Marjolin's ulcer, which is most often a squamous cell carcinoma of aggressive nature. Hence, a general recommendation is that wounds that do not close or that are not likely to close within 3-4 weeks of occurrence should be closed surgically with skin grafting or fasciocutaneous or myocutaneous flaps. This book, Skin Grafts for Successful Wound Closure, focuses on various aspects related to free skin grafts; it does not address flaps. Skin autografts are necessary for providing permanent wound closure. While harvesting a split-thickness skin autograft from the appropriate donor area on the body of the patient, the surgeon is creating a partialthickness wound that needs care for healing. Justifying this new wound and the pain and scarring associated with its healing requires a successful skin graft. Optimal preparation of the recipient wound bed is essential for the success of the graft take.Section I, "Wound Bed Preparation," includes three chapters...