Grafts and Flaps
- Transfer of skin from one donor site to a recipient site (independent of blood supply)
- Graft "takes" by acquiring a blood supply from healthy donor bed
- May be partial thickness (epidermis only) or full thickness (entire epidermis with underlying dermis)
- Dermis does not regenerate
- Epidermis regenerates from the "adnexal elements of skin" - hair follicles, sebaceous glands, sweat glands
Tissues unsuitable for grafting
- Unhealthy, necrotic infected tissue
- Irradiated tissue
- Exposed cortical bone bone without periosteum
- Tendon without peritenon
- Cartilage without perichondrium
Harvesting skin grafts
- Hand-held skin knives: Watson & Braithwaite modifications of Humby knife, electric or gas-powered dermatomes
- Donor site usually one that can be easily concealed - inner thigh, buttock, inner arm
Skin Flap
- Tissue(s) transferred from one site of the body to another
- Maintains a continous blood supply through a vascular pedicle
Classification
- Site
- Local or distant (aka "free flap")
- Contents
- Omentum
- Bowel
- Random or axial (on a named artery)
Indications for flap reconstructions
- Situations where grafts will not take
- When aim is to reconstruct tissue that is "like for like" (bone, joint, tendon, nerve, epithelial lining) to promote optimal structure, function and cosmesis
- When blood supply to an area is of doubtful viability
Reconstruction Ladder
- Healing by secondary intention, then by primary intention
- Skin graft
- Local flap
- Distant flap
- Composite flap
- Island flaps vs pedicaled flaps
- Free flaps
- Composite neurovascular free tissue transfer
