Figure 58

Exposed polytetrafluoroethylene (PTFE) graft. Proper placement of a PTFE graft is crucial for its long-term survival. The graft cannot be too short, as it will deteriorate quickly from puncture limited to only a few sites; if it is too long, however, it will have a greater impedance to flow and a tendency toward thrombosis. The graft should be neither too deep to the skin nor too shallow. When the graft is too shallow, puncture by the dialysis staff is easier, but the skin may be eroded with scarring from repeated use. This photograph shows a linear forearm graft with a segment of exposed PTFE. An exposed graft is a serious problem for several reasons. First, exposure of actual puncture holes eventually leads to hemorrhage. Second, an exposed graft is, by definition, infected. Although some cases have been treated successfully with rotational skin flaps and a long course of antibiotics, the majority do not heal. The ideal treatment is removal of the segment of exposed graft, splicing a segment of new PTFE away from the site of exposure, and allowing secondary wound healing.

How To Reduce Acne Scarring

How To Reduce Acne Scarring

Acne is a name that is famous in its own right, but for all of the wrong reasons. Most teenagers know, and dread, the very word, as it so prevalently wrecks havoc on their faces throughout their adolescent years.

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