SKIN GRAFTING AND TISSUE FLAP nnnnnn.pptx

a omprehensive presentation on the flap and grafts

1. SKIN GRAFTING AND TISSUE FLAP BASIC AND SURGUCAL OVERVIEW Dr.M.Abdullah Post Graduate Resident-II Urology Aziz Bhatti Shaheed Hospital Gujrat

2. OVERVIEW Skin Review Difference between Grafts & Flaps Types of Skin Grafts (according to depth ) How does a skin graft survive Harvesting tools Types Of Flap Indication of flaps

3. SKIN OVERVIEW Skin is composed of three layers Epidermis . Dermis. Subcutaneous fat layer (hypodermis)

4. EPIDERMIS No blood vessels. Relies on diffusion from underlying tissues. Stratified squamous epithelium composed primarily of keratinocytes. Separated from the dermis by a basement membrane.

5. DERMIS Composed of two “sub-layers”: superficial papillary & deep reticular. The dermis contains collagen, capillaries, elastic fibers, fibroblasts, nerve endings, etc.

6. GRAFT VS FLAP GRAFT A skin graft is a tissue of epidermis and varying amounts of dermis that is detached from its own blood supply and placed in a new area with a new blood supply. FLAP Any tissue used for reconstruction or wound closure that retains all or part of its original blood supply after the tissue has been moved to the recipient location.

7. Types of Grafts 1.Split Thickness skin grafts (of vary thickness) : it is removal of full epidermis plus part of dermis from the donor area. Advantages. It Is technically easier Graft take up is better Donor area heals on it’s own Disadvantages Infection Contraction Loss of hair growth Contraindication in the skin grafting over bone, tendon, cartilage and joints

8. 2.Full thickness skin grafts It include both epidermis and full dermis Advantages: Colour match is good No contracture Sensation and function of sebaceous gland and hair follicles retain better Disadvantages: Used only for small area Wider donor area has to be covered with ssg

9. 3. COMPOSITE grafts: It usually composed of skin and fat tissue or skin and cartilages Often taken from the ear margin and useful for rebuilding the missing element of nose, eyelids and fingertip 4 . NERVE GRAFT : Usually taken from the sural nerve but may also be taken from the smaller subcutaneous nerve 5. TENDON GRAFTS: Usually taken from the plantaris or palmaris longus muscle(run just anteromedial to the achilles tendon

10. HOW DOES A SKIN GRAFT SURVIVE 1.STAGE OF PLASMIC IMBIBITION: During 1st 48 hours nourishment of the graft occurs from plasma exudate from host bed capillaries. 2.Inosculation of blood : After 48 hours graft and host vessels form anastomosis. 3.Fibroblast Maturation: Capillary ingrowth completes the healing by fibroblast maturation. The grafts are securely adhered to bed by 10-14 days .

11. Bone Tendon Infected Wound Highly irradiated area What are unsuitable sites for grafting ?

12. TECHNIQUE Knife used: Humby’s Knife Blade; Eschmann blade, Down’s blade Donor area: SSG: Commonly used sites: thigh Other sites Arm, Leg, forearm Dressing is opened after 10 days FULL THICKNESS GRAFT Post-auricular area Supraclavicular area Groin crease area

13. CONTI… RECEPIENT AREA: Area is Scraped well and graft is placed after making window cuts in graft to prevent Development of seroma Graft is fixed and dressing is placed Dressing is opened on 5 th post operative day . Merchurochrome is applied over the recipient margin to promote epithelialization

14. TYPES OF FLAP: 1.Random flaps: They don’t have specific or named blood vessel incorporated in the base of the flap (fig A) 2.AXIAL FLAP: Specific named vascular system that enters the base and run along its axis (fig B)

15. 3.Pedicled flap: The axial blood supply of these flap means that they can be swing around the stalk or even fully islanded 4.FREE FLAP : The blood supply has been isolated, disconnected and then reconnected using microsurgery at the new site (fig C)

16. 5.Composite flap In this type various tissues are transferred together often skin with bone or muscle CONT…

17. INDICATIONS FOR FLAPS TO COVER wider and deeper defects. To cover bone tendon and cartilage. If skin graft repeatedly fails

18. THANK YOU…..!