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Questions and Answers
What is the primary difference between a skin graft and a skin flap?
What is the purpose of a skin graft in the management of skin damage?
What is a consideration when choosing a donor site for a skin graft?
What type of skin graft does not contain the whole dermis?
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What is a common cause of skin graft failure?
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What is a sign of skin graft failure?
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What type of contraction occurs in freshly harvested skin?
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When does full-thickness necrosis typically occur after grafting?
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What is the primary characteristic of a full thickness skin graft?
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Why are split thickness skin grafts commonly used?
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What is a characteristic of skin flaps?
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What is a potential complication of skin flap procedures?
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What is the classification of flaps based on?
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What is the characteristic of a split thickness skin graft?
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What is the common donor site for split thickness skin grafts?
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What happens to the donor site after a full thickness skin graft is harvested?
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What is the donor site for the Deep Inferior Epigastric Perforator (DIEP) flap?
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Which artery is associated with the Transverse Rectus Abdominis Myocutaneous (TRAM) flap?
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What is a common extrinsic factor that can lead to flap failure?
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What is an intrinsic factor that can contribute to flap failure?
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What is the vessel associated with the Latissimus Dorsi Myocutaneous Flap (LDMF)?
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What is the donor site for the Anterolateral Thigh (ALT) flap?
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What is a risk factor for flap failure?
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What is the vessel associated with the Thoracodorsal Artery Perforator (TAP) flap?
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What is the characteristic of a random flap in terms of blood supply?
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What is the primary difference between local and regional flaps?
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What is the term used to describe the process of moving the skin laterally in relation to the pedicle to cover an adjacent defect?
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What type of flap is used for facial defects, fingertip injuries, or defects on the limb?
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What is the term used to describe the process of moving the skin directly forward to cover a defect?
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What type of flap is harvested from a different anatomical region entirely and requires microsurgical techniques?
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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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