Surgery: Skin Grafts and Flaps

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Questions and Answers

What is the primary difference between a skin graft and a skin flap?

The skill level of the surgeon

Its blood supply (correct)

The reason for its use

The type of defect it is used for

When choosing a donor site for a skin graft, what considerations should be made?

The type of anaesthesia used

The size of the defect

The age of the patient

The amount of skin required, the colour and texture of the donor skin, and if hair growth is required (correct)

What type of skin graft contains the whole dermis?

Full-thickness skin graft (correct)

Split-skin thickness skin graft

Split-layer skin graft

Partial-thickness skin graft

What is a common sign of skin graft failure?

Pallor or discolouration at the graft site Signup and view all the answers

What is primary contraction in skin grafts?

The immediate contraction or recoil of freshly harvested skin Signup and view all the answers

What is a common reason for skin graft failure?

All of the above Signup and view all the answers

When does full thickness necrosis of a skin graft typically occur?

1-2 weeks after grafting Signup and view all the answers

What is a common use of skin grafts in wound management?

Managing extensive skin damage, such as deep burns or large skin excision procedures Signup and view all the answers

What type of skin graft contains the full thickness of the epidermis and dermis?

Full Thickness Skin Graft Signup and view all the answers

What is a consequence of using Full Thickness Skin Grafts?

The donor site must be closed using sutures Signup and view all the answers

What is the most commonly used donor site for Split Thickness Skin Grafts?

Thigh Signup and view all the answers

Why are Skin Flaps thought to provide better cosmetic results?

Because the skin tone and texture are usually better matched Signup and view all the answers

What is a potential complication of Skin Flaps?

Flap failure Signup and view all the answers

What is the basis for classifying Skin Flaps according to tissue type?

Compositions utilised in the flap Signup and view all the answers

What type of flap is characterised by the inclusion of muscle tissue?

Musculocutaneous flap Signup and view all the answers

What is a sign of arterial supply issue in Skin Flaps?

Pallor and reduced perfusion Signup and view all the answers

What type of flap relies on a named fasciocutaneous artery that runs beneath the flap's longitudinal axis?

Axial flap Signup and view all the answers

Which type of flap involves moving the skin directly forward to cover a defect?

Advancement flap Signup and view all the answers

What is the term for the attached skin or pedicle that is tunnelled under intact tissue or laid over intact skin in a regional flap?

Skin bridge Signup and view all the answers

Which type of flap is harvested from a different anatomical region entirely and requires microsurgical techniques for reattachment?

Free flap Signup and view all the answers

What is the term for a flap that has no designated named artery that provides blood supply to the flap?

Random flap Signup and view all the answers

What is the term for a flap that is harvested from a contiguous site and is commonly used for facial defects or fingertip injuries?

Local flap Signup and view all the answers

Which artery supplies the Deep Inferior Epigastric Perforator (DIEP) flap?

Deep inferior epigastric artery Signup and view all the answers

What is a common extrinsic factor that can contribute to flap failure?

Wound infection Signup and view all the answers

Which of the following free flaps includes the latissimus dorsi muscle?

Latissimus Dorsi Myocutaneous Flap (LDMF) Signup and view all the answers

What is an intrinsic factor that can contribute to flap failure?

Inadequate arterial inflow Signup and view all the answers

What is the vascular supply of the Anterolateral thigh (ALT) flap?

Descending branch of lateral circumflex artery Signup and view all the answers

What is a common complication that can lead to flap failure?

Haematomas under the flaps Signup and view all the answers

Which flap spares the rectus abdominis muscle?

Deep Inferior Epigastric Perforator (DIEP) flap Signup and view all the answers

What is a systemic factor that can contribute to flap failure?

Systemic hypotension Signup and view all the answers

Study Notes

Skin Grafts and Flaps

Skin grafts and skin flaps are two surgical techniques used to close defects that cannot be closed by primary or secondary intention.
The key difference between a graft and a flap is the blood supply:
- Skin grafts receive blood supply from the recipient site through the vascular bed.
- Skin flaps bring their blood supply from the donor site.

Skin Grafts

Skin grafts have no blood supply and depend on the vascularized bed where they are placed.
Used for extensive skin damage, such as deep burns, large skin excision procedures, or poorly healing ulcerating lesions.
Considerations for choosing a donor site:
- Amount of skin required
- Color and texture of the donor skin
- Hair growth required at the recipient site
Two types of skin grafts:
- Split-skin thickness skin graft (SSG): Does not contain the whole dermis.
- Full-thickness skin graft (FTSG): Contains the whole dermis (including hair follicles).

Skin Graft Failure

Skin grafts must heal by developing a new blood supply.
Failure can occur due to:
- Haematoma or seroma formation under the graft
- Infection (commonly Streptococcus spp.)
- Shearing forces
- Unsuitable bed
- Technical error
Signs of graft failure:
- Pallor or discoloration at the graft site
- Evidence of localized infection
- Systemic features (malaise, lethargy)
- Full-thickness necrosis (occurs 1-2 weeks after grafting)

Skin Flaps

Skin flaps are tissue transferred from a donor site to recipient site along with its corresponding blood supply.
Provide better cosmetic results than skin grafting, with a reduced chance of failure.
Classification:
- By tissue type: Cutaneous flap, fasciocutaneous flap, musculocutaneous flap, or muscle flaps.
- By blood supply: Axial flap, random flap, pedicled (or perforator) flap.
- By location: Local, regional, or free flaps.

Types of Flaps

Local flaps:
- Harvested from a contiguous site
- Used for facial defects, fingertip injuries, or defects on the limb
- Further classified into:
  - Advancement flap: The skin is moved directly forward.
  - Rotation flap: The skin is rotated around a pivot point to cover an adjacent defect.
  - Transposition flap: Moves laterally in relation to the pedicle to cover an adjacent defect.
Regional (or pedicled) flaps:
- Harvested from the same anatomical region but not directly adjacent.
- Attached skin (or pedicle) is tunneled under the intact tissue or laid over intact skin forming a skin bridge.
Free (or distant) flaps:
- Harvested from a different anatomical region entirely.
- Tissue and named fasciocutaneous artery are separated from the donor site before being reattached at the recipient site using microsurgical techniques.

Flap Failure

Extrinsic factors:
- Haematomas under the flaps
- Wound infection
- Systemic hypotension
- Tension of the flaps
- Cigarette smoking
Intrinsic factors:
- Inadequate arterial inflow
- Inadequate venous drainage
- Arterio-venous shunting.

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Description

Learn about skin grafts and flaps, two surgical techniques used to close defects, and understand the key differences between them.