SKIN GRAFT & FLAPS

The skin is the largest organ of the human body.

A protective barrier preventing internal tissues from exposure to trauma, radiation ,temperature changes , and infection

Thermoregulation , through sweating and vasoconstriction / vasodilatation

SKIN

The epidermis constitutes about 5% of the skin, and the remaining 95% is dermis.

Representing approximately 16% of the total body weight.

The skin consists of two main layers: - The outer layer or epidermis, is derived from ectoderm- The thicker inner layer, or dermis, is derived from mesoderm.

Skin varies in thickness in different parts of the body; it is thickest on the palms and soles of the feet, and thinnest on the eyelids.

In general, men have thicker skin than women, and adults have thicker skin than children.

After age 50, however, the skin begins to grow thinner again as it loses its elastic fibers and some of its fluid content.

Use of skin grafts and flaps provides:

± accelerated healing of burns and other wounds

± reduction of scar contracture± enhancement of cosmesis± reduction of insensible fluid loss± protection from bacterial invasion

SKIN GRAFT & FLAPS

A skin graft is a procedure in which healthy skin is removed (harvested) and transferred to another area of the body

Where the skin has been severely damaged by burns, injury, or surgery.

New cells grow from the graft, covering the damaged area with fresh skin.

SKIN GRAFT

Full-thickness skin graft (FTSG)Entire thickness of the dermis is included

Partial or split-thickness skin graft (STSG)Less than the entire thickness of the dermis is included

Split-thickness skin grafts are further categorized based onthe thickness of graft harvested :

Thin (0.005-0.012 inches),Intermediate (0.012-0.018 inches), or Thick (0.018-0.030 inches)

GRAFT SELECTION

 According to biologic relationships :

- Autogenous grafts or autografts comes from the same individual

- Heterogenous graftscomes from sourcesother than the

patient himself

Classification

Split-thickness skin graft (STSG)

Two months post-op Six months post-op

Full-Thickness Skin Graft (FTSG)

Split-thickness skin grafts may be harvested from any surface of the body. Most times, it is an area that is hidden by clothes, such as the buttock or inner thigh.

Full-thickness grafts may be harvested from± upper eyelid± nasolabial fold± pre-and postauricular regions± supraclavicular fossa

The most critical component of successful skin grafting is preparation of the recipient site.

Physiologic conditions must be optimized to acceptand nourish the graft.

Skin grafts will not survive on tissue without bloodsupply.

Wound preparation

The wound also must be free of necrotic tissue and relatively uncontaminated by bacteria.

A skin flap is similar to a graft in that a transplantation of tissue occurs.

The essential difference between the two is that a flap exists on it’s own blood supply.

This means that much larger amounts of tissue can be transported, including muscle if required.

SKIN FLAPS

Based on distance in relation to the defect

Local flapRaised from tissue immediately adjacent to or

very close to the primary defect

Distant flapsTissues moved at a distance from the primary

defect

Classification

Based on composition

SimpleSkin and some subcutaneous tissue

CompoundCarries another tissue such as bone and

cartilage

Classification

Based on blood supply

Random pattern flapDerives its nutrition from the dermal-

subdermal plexus

Microvascular free flapTaken free from other parts of the body

preserving its blood supply, and anastomosed to the available blood supplyin the recipient area

Classification

Neovascularization of the flap usuallyoccurs 3-7 days after transfer.

Advancement Flaps

Pivotal Flaps ( ROTATION )

Pivotal Flaps ( TRANSPOSITION )

Pivotal Flaps ( INTERPOLATIONS )

Rhombic Flaps

Bilobed Flaps

Pectoralis Major Myocutaneous Flap (PMMF)

Deltopectoral FlapTrapezius FlapLatissimus Dorsi FlapSternocleidomastoid FlapForehead Flap

REGIONAL FLAPS

Pectoralis Major Myocutaneous Flap (PMMF)

Deltopectoral Flap

Trapezius Flap

Latissimus Dorsi Flap

Forehead Flap

A skin graft is used to permanently replace damaged or missing skin or to provide a temporary wound covering.

This covering is necessary because the skin protects the body from fluid loss, aids in temperature regulation, and helps prevent disease-causing bacteria or viruses from entering the body.

Skin that is damaged extensively by burns or non-healing wounds can compromise the health and well-being of the patient.

PURPOSE OF SKIN GRAFTING

Areas where there has been infection that caused a large amount of skin loss

BurnsCosmetic reasons or reconstructive surgeries where

there has been skin damage or skin lossSkin cancer surgerySurgeries that need skin grafts to healVenous ulcers, pressure ulcers, or diabetic ulcers

that do not healVery large woundsWhen the surgeon is unable to close a wound

properly

WHY IS IT DONE?

Risks for any anesthesia are:Reactions to medicinesProblems with breathing

RISK

Risks for this surgery are:BleedingChronic pain (rarely)InfectionLoss of grafted skin (the graft not healing, or the

graft healing slowly)Reduced or lost skin sensation, or increased

sensitivityScarringSkin discolorationUneven skin surface

RISK

Once a skin graft has been put in place, it must be maintained carefully even after it has healed.

Grafts on other areas of the body should be similarly supported after healing to decrease the amount of contracture.

AFTERCARE

Grafted skin does not contain sweat or oil glands, and should be lubricated daily for two to three months with mineral oil or another bland oil to prevent drying and cracking.

The severe pain and lengthy period of recovery involved in burn treatment are often accompanied by anxiety and depression

If the patient's burns occurred in combat, a transportation disaster, terrorist attack, or other fire involving large numbers of people, he or she is at high risk of developing post-traumatic stress disorder (PTSD).

Doctors treating the survivors of a nightclub fire in Rhode Island in February 2003 gave them anti-anxiety medications within a few days of the tragedy in order to reduce the risk of PTSD.

The length of time required for a skin graft or flap varies enormously depending on the type, size and situation. A simple split skin graft may take less than an hour, whilst a complicated free flap could last as long as 10 or 12 hours.

HOW LONG IS THE PROCEDURE?

Surgical TherapySeveral methods and materials have been

used in harvesting and securing skin grafts; procedures for STSGs and FTSGs vary substantially.

The procedures also vary among surgeons and circumstances; variations in the tools and techniques of graft harvesting, placement, and care are discussed in Intraoperative details.

TREATMENT

No specific preoperative evaluation is unique to skin grafting.

As with all dermatologic surgery, thorough preoperative history taking is critical ; the history should include information about the patient's medications (particularly those with anticoagulant properties), allergies, bleeding diatheses, frequent or recurrent infections, and general wound healing.

Preoperative Details

Postoperative trauma to the area caused by patient activities (particularly those involving shearing forces), the patient's ability to care for the wounds (at both the donor and recipient sites), and the surgeon's assessment of the patient's expectations.

POST OPERATIVE

Complications include :Death of the grafted tissue (graft failure)Collection of fluid (seroma) or blood

(hematoma) under the graft, which interferes with the regrowth of blood vessels, and

Infection of the donor site or the wound (recipient) site.

Complications

THANK YOUAND

BE HEALTHY