Skin Grafts and Flaps

These are used when a defect can’t be closed by primary or secondary intention.

The main difference between a skin graft and flap is that a skin graft doesn’t take the blood supply with it, whereas a skin flap does. A skin flap usually provides better cosmetic results and has a lower chance of failure compared to skin grafts.

The contraindications of using these things are infection, skin cancer, previous radiotherapy at recipient site, immunosuppression, smoker, poorly controlled DM.

Skin Graft

Types:

• Split-skin thickness – doesn’t contain whole dermis

• Full thickness – contains whole dermis (also transplants hair follicles)

The stages of its implantation at the donor site:

• Haemostasis – Normal response to prevent excessive bleeding

• Plasmatic imbibition (Day 1-2) – Fluid migrates into graft bed, making it oedematous

• Inosculation (Day 2-3) – Vascular network slowly begins to form

• Re-innervation (Week 2-4) – Sensation may take months to yrs to return or may go back to normal