Grafting is used to repair large wounds and defects by
dissecting out and freeing (not detaching it completely) the
skin, underlying muscle and tissues from the area adjacent to
the wound. These Skin Flap Grafts can then be rotated and
stitched over the wound to fill the defect and replace the
Skin Grafting vs.
Skin Flap Grafting - What is the difference?
Skin Grafting - Skin
Grafting is a means of reconstructing a defect in the
continuity of healthy skin. In this surgical procedure, skin
from another part of the body (Skin Graft from a donor site)
or or an artificial skin substitute is transplanted to
reconstruct the defect (recipient site).
Skin Flap Grafting - In Skin Flap Grafting, the grafted
tissues have an intact blood supply. Flap Grafts may consist
of skin, subcutaneous tissues, muscle, bone or omentum.
What are the
variants of Flap Grafts?
Flap Grafts can be
Skin Flap Grafts - Skin
Flaps or Skin Flap Grafts can be sub-divided in to 2
categories depending on whether they can be moved to a
local (adjacent to the wound area) or distant
(non-adjacent) graft site.
Local Skin Flaps
Random Pattern Skin Flaps -
The blood supply for this kind of Skin Flaps comes from
blood vessels in the dermis and below the dermis (musculocutaneous
blood vessels). This method of Skin Flap Grafting is used
for reconstruction of a facial defect.
Rotational Skin Flaps -
Those which rotate about in to the adjacent wound area to
fill the defect.
Transpositional Skin Flaps
- This kind of Skin Flap is rectangular in shape and
rotates to alternate it's position to cover the wound
Advancement Skin Flaps -
These Skin Flaps can be single pedicle, bipedicle or V-Y
Rhomboid Skin Flaps
Axial Pattern Skin Flaps -
This kind of Skin Flap uses blood supply directly from a
cutaneous artery and it's accompanying vein. It may have a
pedicle which encourages the flap to increase its blood
supply e.g. forehead flap supplied by superficial temporal
Myodermal, Myocutaneous or
Musculocutaneous Skin Flaps - The blood supply for this
kind of Skin Flaps comes from the underlying muscle as the
skin and the underlying tissues including the muscle are
all moved as a single unit. The musculocutaneous Skin
Flaps can be:
Free Skin Flap - This
kind of Skin Flaps are detached completely from it's
blood supply and transferred to another part of the body
where the blood supply would be re-established using
Microvascular Surgery techniques e.g. free transverse
rectus abdominis Skin Flap
Peninsular Skin Flap -
Skin and Blood vessels are intact in the Skin Flap
Island Skin Flap - Blood
vessel is intact but no skin in the pedicle of the Skin
Distant Skin Flaps
Direct Skin Flap - A
direct Skin Flap is transferred to a distant site
directly so that the donor and recipient sites are
brought close together. After 1 - 3 weeks the Skin Flap
is freed completely.
Tube Pedicle Skin Flap -
The tube Skin Flap is transferred to a recipient site
with the lateral flap edges stitched together.
Microvascular Skin Flaps
- In this type of Skin Flaps the blood vessels are
completely detached from it's pedicle and anastomosed to
the local blood vessels at the recipient site using
Microvascular Surgery techniques.
Tissue Expansion Skin
Flaps - Tissue expanders can be placed subcutaneously to
expand adjacent skin prior to Skin Flap Grafting
operation. The tissue expander can be inflated by
filling it with saline. The expanded skin can be used
for Skin Flap Grafting and the tissue expander removed
after the procedure.
Tendon Grafts - These are
used to replace missing or non-functioning tendons
Bone Grafts - They are used
for the defects of facial bones, skull and long bones of
Cartilage Grafts - This
procedure is used to restore the cartilage of ear and nose
Fascia, nerve, muscle,
blood vessel, fat Grafts - These Grafts are used to
restore the contour and defects in their respective
What are the factors
that effect the outcome of Skin Flap Grafting?
Several factors play a key
role in determining the success or failure of Skin Flap
Grafting procedure, some of which include:
To ensure viability of the
Skin Flap Graft, the recipient site should be evaluated
carefully for color, texture, thickness and size of the
wound area to be covered to achieve cosmetic objectives.
To restore of the function
of the affected part.
observation to monitor the viability of Skin Flap. A
healthy pink color and warm to touch are reliable pointers
for clinical assessment of viability.
Important factors to
consider here are your overall health, smoking, any
medical conditions like diabetes, hypertension, scarring
due to previous surgical procedure(s), any past injuries,
Skin Flap Graft
Vascularity of Skin Flap
Tension causing kinking or
torsion (twisting) of the pedicle
The elasticity and
vascularity of Skin Flap
Injuring the blood supply
during dissection of the Skin Flap Graft from the donor
Benefits of Skin
Wounds in areas of the body
that are difficult to re-construct or repair like neck, front
of the elbow or back of the knee are ideal places for Skin
Flap Grafting as the Skin Flap Grafts in these areas will not
contract and have a close match of skin color. Skin Flap
Grafts are capable of sensation.
Risks of Skin Flap
Failure of Skin Flap
Grafting (rejection of the Skin Graft, infection or poor
healing) and need for a repeat procedure.
Hematoma or accumulation of
blood underneath the Skin Flap Graft
Weeping (oozing) of
brownish, clear fluid or blood from the graft site
Formation of necrotic
Skin redness surrounding
the graft site
Pain and ulceration
Distortion due to pulling
away of Skin Graft
Alternatives to Skin
Skin Grafting - Skin
Grafting is a useful way to prevent infection and further
progression of the wounds, such as diabetic ulcers, venous
ulcers, pressure sores, after removal of skin tumor, Full
Thickness Burns and deep lacerations. It is extremely crucial
to match the color of the skin from the donor site to the
recipient site (where skin would be transplanted to) to reduce
the chances of a patchy appearance.
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