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Questions and Answers

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

  • The type of skin damage being treated
  • The presence of a blood supply (correct)
  • The level of hair growth required
  • The location of the donor site

    • What is the purpose of a skin graft in the management of skin damage?

  • To promote primary intention healing
  • To provide immediate blood supply to the damaged area
  • To stimulate hair growth
  • To cover extensive skin defects (correct)

    • What is a consideration when choosing a donor site for a skin graft?

  • The type of anaesthesia used
  • The colour and texture of the donor skin (correct)
  • The age of the patient
  • The patient's medical history

    • What type of skin graft does not contain the whole dermis?

    <p>Split-skin thickness skin graft (SSG)</p> Signup and view all the answers

    What is a common cause of skin graft failure?

    <p>All of the above</p> Signup and view all the answers

    What is a sign of skin graft failure?

    <p>All of the above</p> Signup and view all the answers

    What type of contraction occurs in freshly harvested skin?

    <p>Primary contraction</p> Signup and view all the answers

    When does full-thickness necrosis typically occur after grafting?

    <p>1-2 weeks after grafting</p> Signup and view all the answers

    What is the primary characteristic of a full thickness skin graft?

    <p>It contains the full thickness of the epidermis and dermis</p> Signup and view all the answers

    Why are split thickness skin grafts commonly used?

    <p>They are used for skin defects that are too large for a full thickness graft</p> Signup and view all the answers

    What is a characteristic of skin flaps?

    <p>They provide better cosmetic results than skin grafting</p> Signup and view all the answers

    What is a potential complication of skin flap procedures?

    <p>Flap failure</p> Signup and view all the answers

    What is the classification of flaps based on?

    <p>Tissue type, blood supply, or location</p> Signup and view all the answers

    What is the characteristic of a split thickness skin graft?

    <p>It contains the full epidermis with a variable thickness of dermis</p> Signup and view all the answers

    What is the common donor site for split thickness skin grafts?

    <p>All of the above</p> Signup and view all the answers

    What happens to the donor site after a full thickness skin graft is harvested?

    <p>It is closed using sutures</p> Signup and view all the answers

    What is the donor site for the Deep Inferior Epigastric Perforator (DIEP) flap?

    <p>Skin and subcutaneous tissue of lower abdomen</p> Signup and view all the answers

    Which artery is associated with the Transverse Rectus Abdominis Myocutaneous (TRAM) flap?

    <p>Deep inferior epigastric artery</p> Signup and view all the answers

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

    <p>Wound infection</p> Signup and view all the answers

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

    <p>Inadequate venous drainage</p> Signup and view all the answers

    What is the vessel associated with the Latissimus Dorsi Myocutaneous Flap (LDMF)?

    <p>Subscapular artery</p> Signup and view all the answers

    What is the donor site for the Anterolateral Thigh (ALT) flap?

    <p>Skin and subcutaneous tissue of anterolateral thigh</p> Signup and view all the answers

    What is a risk factor for flap failure?

    <p>Cigarette smoking</p> Signup and view all the answers

    What is the vessel associated with the Thoracodorsal Artery Perforator (TAP) flap?

    <p>Thoracodorsal artery</p> Signup and view all the answers

    What is the characteristic of a random flap in terms of blood supply?

    <p>It receives blood supply via the subdermal plexus.</p> Signup and view all the answers

    What is the primary difference between local and regional flaps?

    <p>The location of the donor site.</p> Signup and view all the answers

    What is the term used to describe the process of moving the skin laterally in relation to the pedicle to cover an adjacent defect?

    <p>Transposition.</p> Signup and view all the answers

    What type of flap is used for facial defects, fingertip injuries, or defects on the limb?

    <p>Local flap.</p> Signup and view all the answers

    What is the term used to describe the process of moving the skin directly forward to cover a defect?

    <p>Advancement.</p> Signup and view all the answers

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

    <p>Free flap.</p> 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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