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Management of skin loss

anagement of skin loss

Somsak

omsak

Masomboon MD FRCST. FICS

asomboon MD FRCST. FICS

.

Plastic and Reconstructive Surgery

lastic and Reconstructive Surgery

Siriraj Hospital Medical School

iriraj Hospital Medical School

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Principle of Treatment

rinciple of Treatment

Skin loss

kin loss

Process of Healing

rocess of Healing

Partial thickness

artial thickness

- Regeneration or

egeneration or

- Epithelialization

pithelialization

Full thickness

ull thickness

- Primary closure

rimary closure

- Repair scar)epair scar)

- Skin graft

kin graft

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Grafts = Transplants

rafts = Transplants

1.

.

Definition of grafts

efinition of grafts

ll.

l.

Classification of graftslassification of grafts

A. Methods of grafting

. Methods of grafting

1. Free grafting

. Free grafting

2. Flap grafting. Flap grafting

3. Vascular

. Vascular

anastomosis

nastomosis

grafting

rafting

B. Species of origin

. Species of origin

1.

.

Autologous

utologous

Auto) graft

Auto) graft

2. Homologous Homo,

. Homologous Homo,

Allo

llo

) graft

graft

3.. Heterologouseterologous Hetero.Hetero. Xenoeno) graftgraft

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Free Skin Graftree Skin Graft

1. Definition

. Definition

2. Composition : Epidermis, dermis

. Composition : Epidermis, dermis

Skin appendages

kin appendages

3. Recipient area

. Recipient area

A.

.

Take

ake

B.

.

No Take

o Take

1. Fat, fascia. Fat, fascia 1. Compact bone. Compact bone

2.

.

Muscle,tendon

uscle,tendon

sheath 2. Bare cartilage

heath 2. Bare cartilage

3.

.

Periosteum

eriosteum

3. Bare tendon

. Bare tendon

Perichondriumerichondrium 4. Heavily irradiation. Heavily irradiation

Cancellous

ancellous

bone

one

tissue

issue

4.

.

Meninges

eninges

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4. Types. Types

A. Partial Split) thickness skin graft

. Partial Split) thickness skin graft

1. Thin split graft or

. Thin split graft or

Thiersch

hiersch

s graft

raft

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5. Factor affecting the take of free skin graft

. Factor affecting the take of free skin graft

1. Recipient site capable for producing

. Recipient site capable for producing

capillary bud.apillary bud.

2. Approximation between the graft and

. Approximation between the graft and

recipient site : No

ecipient site : No

hematoma

ematoma

or

r

infection)

nfection)

3.

.

Immobilisation

mmobilisation

during the phase of

uring the phase of

graftingrafting

6. Subsequent behavior of free graft

. Subsequent behavior of free graft

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7. Graft cutting instruments. Graft cutting instruments

1. Skin graft knife

. Skin graft knife

- Blair,

lair,

Humby

umby

, Braithwaite

Braithwaite

2. Drum dermatome

. Drum dermatome

- Padgett

adgett

Hood, Reese

ood, Reese

3. Electric dermatome. Electric dermatome

- Brown

rown

- Padgettadgett

- Stryker

tryker

- Castroviejoastroviejo

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8. Application of partial thickness skin. Application of partial thickness skin

graft

raft

1. Sheet

. Sheet

2. Postage

. Postage

stamp graft, patch

tamp graft, patch

3. Strip graft

. Strip graft

4. Mesh graft. Mesh graft

9. Storage of skin graft

. Storage of skin graft

At 4t 4

C -: 44 6 weeksweeks

Freezer

reezer

-: 2 months

2 months

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Skin Flaps

kin Flaps

Definition

efinition

Classificationlassification

l. Due to blood supply

. Due to blood supply

1. Random pattern flap. Random pattern flap

2. Axial pattern flap

. Axial pattern flap

ll. Due to site of flapl. Due to site of flap

1. Local flap

. Local flap

2. Distant flap. Distant flap

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Local skin flapsocal skin flaps

1. Flap rotating about a pivot point. Flap rotating about a pivot point

- Rotation

otation

- Transposition : Rhomboid flapransposition : Rhomboid flap

- Interpolation

nterpolation

- Z-Plasty

lasty

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Local skin flapsocal skin flaps

2. Advancement skin flap

. Advancement skin flap

- Single pedicle advancement flap

ingle pedicle advancement flap

- Rectangular or square flap

ectangular or square flap

- V-Y advancement flap

advancement flap

- Bipedicle

ipedicle

advancement flap

dvancement flap

or. H. flap

r. H. flap

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Distant flap

istant flap

1. Direct

. Direct

2. Indirect

. Indirect

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