A blood vessel or graft lying in an open wound has no protection. It dries, becomes colonised, and the wall weakens until it bleeds, often suddenly and heavily. Covering it with living tissue is the treatment, and it is urgent.
Coverage of exposed vessels means bringing healthy, well perfused tissue over an artery, vein or vascular graft that is lying exposed in a wound. A skin graft is not enough, because it needs a vascular bed and provides no bulk. A flap, either moved from nearby or transferred from elsewhere with microsurgery, is usually required, and it is done urgently to prevent infection and catastrophic bleeding.
Skin and fat exist partly to keep the structures underneath moist, warm and protected. When an artery, vein or synthetic graft ends up in an open wound, none of that applies. The surface dries out, bacteria colonise it within days, and infection eats into the wall. The wall then fails, usually without warning, and the bleeding that follows can be fatal.
Dressings delay this rather than prevent it. A skin graft does not solve it either, because a graft needs a blood supply from the bed it sits on, and a bare vessel or a plastic graft cannot supply one. Even where a skin graft does take around the edges, it is paper thin and offers no protection against pressure or a second injury.
What works is a flap: tissue brought in with its own blood supply. That supply is what fights infection, and the bulk is what protects the vessel. A muscle flap is often chosen because muscle is particularly good at controlling infection and moulds well into an irregular cavity. Where no local tissue is available, tissue is transferred from a distant site and its vessels joined to vessels near the wound under a microscope.
The question is rarely whether to cover, but with what, and how urgently.
The vessel or graft is inspected, and a decision made about whether it can be kept or must be replaced.
All dead and infected tissue is removed. Cover placed over infected tissue fails.
A nearby muscle is used where one is available. Where the area has been irradiated or previously operated, tissue is brought from elsewhere.
The flap is raised on its blood supply and laid over the vessel so that it is completely buried in living tissue.
For a free flap, its artery and vein are joined to vessels near the wound under a microscope.
The donor area is closed directly or with a skin graft.
The flap is checked repeatedly for colour and blood flow. This is when a microsurgical join is most likely to fail and can often be rescued if caught early.
Antibiotics continue if there was infection. Mobilisation begins carefully, avoiding pressure on the flap.
The flap settles and softens. Donor site heals. Physiotherapy addresses any stiffness.
The flap can be thinned or revised if bulk is a problem. Ongoing surveillance of the underlying graft continues.
A well chosen flap usually settles the wound and removes the risk of blowout, and that is the main aim. The flap itself is bulky at first and often needs thinning later if appearance matters. The donor site leaves a scar, and where muscle has been taken there may be some measurable weakness, though rarely enough to affect daily life. If the underlying graft is already deeply infected, cover alone may not save it and the graft sometimes has to be removed and the circulation rerouted.
Flap surgery in an infected field around a vessel carries specific risks, and they are higher than for elective reconstruction.
The first week is about protecting the flap's blood supply and keeping pressure off it.
Skin does not grow reliably over a bare vessel or a plastic graft, and while you wait it is becoming infected. Time works against you here.
A skin graft needs a bed with a blood supply to grow into. A bare vessel or synthetic graft cannot provide one, and even where a graft takes it is too thin to protect anything.
Cover plus thorough debridement plus antibiotics treats infection. Cover alone over infected tissue fails, which is why the debridement is not negotiable.
This problem sits exactly between vascular surgery and plastic surgery, and it is frequently passed between the two. Being able to assess the vessel and provide the cover in one operation is what prevents the delay that leads to a bleed.
Usually part of an emergency or complication related admission and covered on the same basis by health insurance and government schemes. Cost depends on whether a local flap or a microsurgical free flap is needed and on the length of stay. A written estimate follows assessment.
Most of these come from patients who have been told a wound is not healing.
Ask your question →Urgent. An exposed and colonised vessel can bleed suddenly and heavily, and that bleed can be fatal. A small warning bleed is a reason to be admitted the same day, not to watch and wait.
A skin graft survives by growing into the blood supply of the surface it is laid on. A bare artery or a synthetic graft has no such surface to offer. Even if the graft took at the edges it would be far too thin to protect the vessel.
Not always. If infection is superficial and the graft itself is sound, good debridement plus a muscle flap frequently saves it. If the graft is deeply infected, removing it and rerouting the circulation is safer, and that judgement is made at the operation.
Usually little that you notice in daily life, because other muscles compensate. Specific losses depend on which muscle is used, and that is discussed with you beforehand.
Press hard directly on the wound with whatever is to hand and keep pressing. Call an ambulance. Do not drive yourself, and do not release the pressure to look.
Seeing patients from across the city and beyond: read about the practice on the plastic surgeon in Surat page, or check what a written estimate covers on the costs and insurance page.
