Plastics: Skin Grafts and Flaps

Andrew Street
Flashcards by Andrew Street, updated more than 1 year ago
Andrew Street
Created by Andrew Street almost 4 years ago


SGUL LOB's for Plastics: Skin Grafts and Flaps.

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3610 Describe the difference between a skin graft & a skin flap. A skin graft is a piece of dermis & epidermis that is completely removed from its original bodily attachment (the donor site). It is fixed to a recipient site & develops a new BD supply from the underlying tissue. A flap is a unit of tissue that maintains its own blood supply while being transferred from donor to recipient site. OHCS.
3611 Identify the different types of skin grafts, their main uses & donor sites. Split thickness skin grafts: • Consist of epidermis plus a variable thickness of dermis. • Harvested by shaving off a layer of skin with a skin graft knife or dermatome. Can be taken from any area of the body (thigh skin most often used—plentiful & easy to access). • Graft is often fenestrated (to stop blood or serous fluid collecting under it) or meshed (to expand the graft and allow it to contour to the wound bed). • Graft secured with glue, sutures, or staples, then a non-adherent, compressive dressing. Inspected after 5 days. • Defect heals by re-epithelialization from skin appendages. Full thickness skin grafts: • Contain epidermis plus the entire thickness of dermis. • Adnexal structures, e.g. hair, are included. • Harvested by elliptical excision from sites of skin laxity, e.g. post-auricular skin crease, supraclavicular, preauricular, groin, or medial upper arm skin. • Graft secured with a tie-over dressing, e.g. proflavine-soaked cotton wool, & inspected after a week. • Donor site sutured closed. OHCM.
3612 What factors affect wound healing? * Age * Nutritional Status * Infection * Immune Status * Comorbidities - esp diabetes * Smoking * Previous irradiation * Immobility * Incontinence From lecture:
3612 What are some reasons for graft failure? • Shearing - revascularization cannot occur if the graft is mobile. • Infection - either of the bed or the graft tissue. • Separation of graft from its bed - by haematoma or seroma. • Inadequate bed, e.g. bare cortical bone, tendon without paratenon. • Damage to the graft - e.g. poor surgical technique, excessive dressing pressure. OHCS
3613 Describe the different types of skin flaps & the situations in which they are most suitable. * Random pattern local flaps: > Available local tissue manipulated to fit a wound without disrupting BD supply > Donor tissue is adjacent to wound > Donor site is closed directly > BD supply is random pattern * Pedicled flaps: > Larger mass of tissue with a recognised BD supply > BD supply maintained via a pedicle > Can be local or distant to the wound * Free flaps: > Free transfer of tissue from one part of the body to another > Any tissue - skin, fat, muscle, bone > Tissue is detached from its BD supply > Reconnection of new blood supply > Requires microscope From lecture:
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