Skin Graft & Flap - Types, Technique, Advantages & Disadvantages

This topic usually follows the topic - Burns or Skin Tumors...As a MBBS Students, they should know the types of Skin graft/flaps as well as the procedure, when and where to be used. Particularly in cases of Flap reconstruction, they should know about the blood supply of the flap that is being used....Mostly this topic is important theoretically as well as clinically.... 

1. Prof. U.Murali.
Skin Graft
&
Flap

2. LEARNING OBJECTIVES
◼Define Graft & Flap. List out the types of grafts & flaps.
◼Identify the Stages of graft intake.
◼Explain in short, the technique of Split skin grafting.
◼Mention the advantages & disadvantages of grafts & flaps.

3. SKIN GRAFT - DEFINITION
◼It is transfer of skin from
one area to the required
defective area.
◼It is an autograft.

4. SKIN GRAFT - TYPES
Split/Partial Thickness
{Thiersch graft}
•It is removal of
full epidermis &
part of the dermis
– donor site.
•Thin SSG
•Thick SSG
Full Thickness
{Wolfe graft}
•It includes both
epidermis & full
dermis.
•It is used over the face,
eyelid, hands and over the
joints.
•Harvesting sites –Groin
crease, Supra-clavicular
skin & Post-auricular
region.
Composite Graft
•Are a combination of
skin & another tissue
type, such as fat or
cartilage.
•Often taken from the
ear margin and useful
for rebuilding missing
elements of nose,
eyelids and fingertips.

5. STAGES OF GRAFT - INTAKE
Plasma Imbibition
•Diffusion of
nutrition between
recipient bed &
graft.
•So a thin layer of
plasma forms
between them.
Inosculation
•Vessels in the
graft connect with
those in the
recipient bed.
Neovascularisation
•Graft re-
vascularised by in
growth of new
vessels into the
bed.

6. INDICATIONS – SKIN GRAFT
◼Well granulated ulcer.
◼Clean wound which cannot be
opposed.
◼Post-surgery to close the defect
created.
◼Cosmetic reasons –
reconstructive surgeries.

7. HARVESTING TOOLS
◼Humby’s Knife | Dermatome
◼Blade – Eschmann blade
◼Wooden board
◼Oil / Lignocaine Jelly
◼Others

8. TECHNIQUE
◼Donor area: Cleaned & draped.
Using H K – graft is taken, fine
punctate bleeding is observed.
Later it is dressed & dressing
done.
◼Recipient area: is scraped well
and graft is placed making
window cuts in the graft. It is
fixed and tie-over dressing is
placed.

11. DISADVANTAGES - STSG
◼Contracture of graft.
◼Seroma & hematoma formation.
◼Infection – Streptococcus spp.
◼Loss of hair growth.
◼Blunting of sensation.
◼Dry, scaling of skin.
◼Graft failure.
◼Technically easier.
◼Wide area of recipient can be covered.
One such example – by passing the graft
through a Mesher…
◼Graft take up is better.
◼Donor area heals on its own.
ADVANTAGES - STSG

12. FULL THICKNESS GRAFT
ADVANTAGES
OTHER GRAFTS
◼Color match – good
◼No contracture
◼Sensation / Hair follicle
retained
◼Cosmetic results – better
◼Tendon graft
◼Bone graft
◼Nerve graft
◼Venous graft
◼Corneal graft
◼Combined graft
◼Reverdin graft
DISADVANTAGES
◼Used – for small areas
◼Wide donor area to be
covered – to close the
defect

13. FLAP - DEFINITION
◼It is transfer of donor tissue
with its blood supply to the
recipient area.
◼Parts of Flap –
Base / Pedicle / Tip

19. DISADVANTAGES - FLAP
◼Long-term hospitalization.
◼Infection.
◼Kinking, rotation & flap
necrosis.
◼Staged procedure.
◼Good blood supply / Good
take up.
◼Gives bulk, texture & color to
the area.
◼Allows required movements -
recipient area.
◼Cosmetically better.
ADVANTAGES - FLAP

20. FLAP - INDICATIONS & TYPES
Indications
•To cover wider /
deeper defects.
•To cover over bone /
tendon / cartilage.
•If skin graft fails –
repeatedly.
Random pattern
•No known blood
vessels supplying, but
the basis is sub-
dermal plexus of
blood vessels.
Axial pattern
•A known blood vessel
supply it. Superficial
pedicles pass along
their long axes.
•It is a lengthy flap.

23. 23

26. FLAP
TRANSPOSITION FLAP ROTATION FLAP
◼When the flap moves
laterally it is called as T F.
◼When T F – moves laterally
to close the defect – creates
raw area in its original place
– must be covered with SSG.
◼When the flap rotates
laterally towards
defect it is called as
R F.

27. FLAP
‘Z’ PLASTY FREE FLAPS
◼It is transposition of 2
inter-digitating ∆ flaps.
◼Used in managing -
- contracted scars
- facial scars
- Dupu. contracture
- to cover P S defect.
◼Vascular pedicle –
flap , both artery &
vein are
anastomosed to
recipient vessels
using microscopes.

28. TYPES – TISSUE TYPE IN THE FLAP
◼Cutaneous flap – Forehead & delto-pectoral flap
◼Fasciocutaneous flap – Radial forearm & groin flap
◼Muscle flap – G M M F / Gracilis flap / T F L M F
◼Myocutaneous flap – PMMCF / LDF – Composite flap
◼Osteo M C F – Radius + BR + Skin / Ribs + IM + Skin
◼Omental flap

29. FOREHEAD FLAP

30. DELTOPECTORAL FLAP

31. R F F / GROIN FLAP

32. P M M C FLAP

33. CROSS LEG FLAP

34. REFERENCES

35. TO SUMMARIZE
◼Definition of graft / flap. Types of graft.
◼Classification of flaps.
◼Stages of graft intake.
◼Indications of graft & flap.
◼Technique of split skin grafting.
◼Advantages & disadvantages of graft & flaps.
◼Myocutaneous & Faciocutaneous classification - flaps.
◼Various examples of tissue types used in flaps.

36. QUESTION TIME
◼Define Graft / Flap.
◼List out the types of graft.
◼Identify the stages of graft intake.
◼Classify flap – Cormack & Lamberty.
◼List 4 disadvantages of STSG.
◼Differentiate between transposition from rotation flap.
◼List 5 examples of tissue types used in flaps.
◼Classify myocutaneous flap.

37. Within 48 hours of transplantation, skin graft survives due to –
▪A. Amount of saline in graft.
▪B. Plasma imbibition.
▪C. New vessels growing from the donor tissue.
▪D. Connection between donor & recipient capillaries.

38. The subdermal plexus forms the vascular basis for –
▪A. Randomized faps.
▪B. Axial flaps.
▪C. Musculocutaneous flaps.
▪D. Fasciocutaneous flaps.

39. All are advantages of Split T S Grafting, except –
▪A. Good uptake.
▪B. Reusable donor site.
▪C. Less contraction.
▪D. Large grafts can be harvested.

40. One of the following is not a characteristic feature of
flap, according to Cormack & Lamberty classification -
▪A. Construction.
▪B. Conformation.
▪C. Composition.
▪D. Combination.

41. Skin grafting is absolutely contraindicated in which of
the following skin infection? -
▪A. Staphylococcus.
▪B. Pseudomonas.
▪C. Streptococcus.
▪D. Proteus.