Checklist

WIPER

Physiological parameters

General

• Note any scars, deformities or skin lesions. Offer to inspect the whole body.

Inspection

• Identify any flaps and grafts, and describe any scars present (see Chapter 40, Examination of scars).

• Comment on the location.

• Flap:

• site and size

• type of flap: local, regional or distant

• phase of healing: well-healed, immaturity of scar, adequacy of outcome

• check donor sites or exposure scars

• Graft:

• site, size and colour match of graft

• type of graft:

– pattern of scarring: split-thickness skin graft (STSG) or full-thickness skin graft (FTSG)

– cobblestone or crocodile skin appearance (derived from a meshed graft)

• healing: graft take as a percentage

• bed of flap: muscle flap/native muscle/fat

• Check common graft donor sites:

• upper thighs for STSG

• inner upper arms, supraclavicular fossa, retroauricular, groins for FTSG

Palpation

• Consistency: thickness, pliability, contour

• Vascular supply: colour, capillary refill

• Neurology: sensation

• Base:

• firm (recurrent disease or scarring)

• fluctuant (seroma or haematoma)

To complete the examination…

• Inspect for donor sites and any other scars/skin lesions.

• Offer to palpate regional lymphatic drainage sites if previous cancer excisions.