Principles of grafts and flaps for reconstructive surgery
- Donald Morris, MD
Donald Morris, MD
- Assistant Professor of Surgery - Part Time
- Harvard Medical School
The routine use of grafts and flaps has dramatically broadened the ability of the surgeon to perform reconstructive surgery and improve outcomes and quality of life for trauma patients, burn patients, and cancer patients.
This topic provides an overview of the use of grafts and flaps in reconstructive surgery. Reconstructive surgical procedures for specific clinical problems are discussed elsewhere. (See "Overview of breast reconstruction" and "Mandibular and palatal reconstruction in patients with head and neck cancer" and "Principles of burn reconstruction: Overview of surgical procedures".)
A skin graft is the transfer of skin from a donor site to a recipient site. The transplanted skin does not have a blood supply and initially survives by absorbing transudate from the recipient site, a process called plasmatic imbibition . Neovascularization from the graft bed capillaries then provides a blood supply to the graft over the next 48 to 72 hours. Full circulation is restored within four to seven days.
In contrast to a skin graft, a flap carries its own blood supply and is therefore not dependent on the recipient bed to revascularize the tissue. Flaps are discussed below. (See 'Flaps' below.)
Indications for skin grafting
●Skin grafts are indicated for coverage of a skin defect due to trauma, burns, or excision of a tumor if closure cannot be accomplished by approximating the edges of the wound. (See "Closure of minor skin wounds with sutures".)
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- SKIN GRAFTS
- Indications for skin grafting
- Types of skin grafts
- - Split-thickness skin grafts
- - Full-thickness skin grafts
- Choice of split- versus full-thickness grafts
- Surgical technique for skin grafts
- - Donor site selection
- - Recipient site preparation
- - STSG technique
- - FTSG technique
- Graft maturation
- Graft failure
- Indications for flap coverage
- Blood supply
- Site preparation for flaps
- Flap choice
- Types of flaps
- - Local flaps
- - Regional flaps
- - Distant flaps
- Pedicled flaps
- Free flaps
- Prelaminated and prefabricated flaps
- Flap composition
- - Skin flaps
- - Muscle flaps
- - Musculocutaneous flaps
- - Fasciocutaneous flaps
- - Osteocutaneous flaps
- Flap complications
- - Vascular compromise
- - Other flap complications
- GRAFTS VERSUS FLAPS
- SUMMARY AND RECOMMENDATIONS