FAVOURABLE GRANULATIONS
A graft is more likely to take if: the granulations are young (48 to 72 hours), firm, flat, rough, bright red and bleed when you touch them; if there is the minimum of discharge which is not purulent; if there are no signs of infection in the skin round the wound; and if active epithelialization is taking place round the edges of the wound which are gently sloping.
UNFAVOURABLE GRANULATIONS
A graft is less likely to take if: the granulations are old (more that 72 hours), pale and avascular, soft, heaped up above the surface of the wound; if they are thick, slimy, soggy, gelatinous, oedematous, or friable; if they do not bleed readily when you touch them; if there is a purulent discharge; if there is warm, red skin round the wound, or if there is lymphangitis or acute lymphadenitis.
PREPARING GRANULATIONS FOR GRAFTING
Always scrape away most of the granulations from the base of a wound, unless they are very thin and are a good colour. This makes little difference to the chance of the graft taking, but much less fibrous tissue will form under it, the cosmetic result will be better and a contracture will be less likely to form.
If granulations are in a very unfavorable state for grafting, you will have to prepare them first.
If the granulations are pale and avascular, excise and curette them, together with the fibrous base of the wound.
If the granulations are unfavourable in other ways, you can dress them. The important factor is not so much what dressing you put on, but how often you change it.
Apply dressings soaked in: (1) Saline, if possible changed 3 times daily. This is possibly the best. (2) Hypochlorite (’Eusol’, or chlorinated lime and boric acid solution BPC). (3) 0.5% acetic acid. (4) Hydrogen peroxide.
LESS ORTHODOX APPLICATIONS FOR INFECTED WOUNDS
often work, and may make granulation tissue fit for grafting. You may have nothing else. Scientific explanations can be postulated for some of them, particularly sugar. They include: (1) Mashed fresh papaya (paw paw) applied between layers of gauze. A slough will appear the following day and the skin round the wound will become red. (2) A ‘swab and honey’ applied honey side down. (3) Honey dripped into the wound (this is said to be useful in bed sores). (4) Sugar. (5) Salt. (6) Fresh placenta. (7) Amniotic membrane. (8) Yoghourt is particularly useful if a wound is very offensive. (9) Plaster of Paris over vaseline gauze or plain gauze.
If you use sugar, open the wound widely, dry it with gauze, completely fill it with granulated sugar, and add more sugar as this becomes diluted.
