List all the options available in providing cover to a skin wound

This is known as the reconstructive ladder starting with the simplest method and if not suitable moving on to the next (more complex) method aiming to achieve the best result.

1. Simple dressing and allowing healing by secondary intention

2. Direct primary closure

3. Delayed primary closure

4. Skin graft

5. Local flap

6. Free flap

What are the two main types of skin graft? What are the advantages and disadvantages of each?

The two main types are full or partial thickness skin graft.

Partial-thickness grafts are available in larger sizes and can be used to cover large defects, as the donor site does not require closure. They are also meshed which improves their ability to “take” and to conform to irregular shaped defects. In the long term however they have a poorer cosmetic outcome. There may also be problems with the donor site during the healing process.

Full-thickness grafts have a better cosmetic outcome and match the surrounding skin better. There are fewer problems with the donor site as they are closed directly. Full-thickness grafts are available in small sizes however and cannot be used to cover very large defects. For example the full-thickness grafts used to cover skin defects in the fingers, after a Dupuytrens dermatofasciectomy. These grafts are taken from the volar forearm skin.

What are the causes of skin graft failure and what measures are undertaken to counteract them?

Infection Presence of a high bacterial load can lead to graft failure.