Skin Flap Grafting :

Skin Grafting vs. Skin Flap Grafting - What is the difference?

Skin Grafting - Skin Grafting is a means of reconstructing a defect in the continuity of healthy skin. In this surgical procedure, skin from another part of the body (Skin Graft from a donor site) or or an artificial skin substitute is transplanted to reconstruct the defect (recipient site).
Skin Flap Grafting - In Skin Flap Grafting, the grafted tissues have an intact blood supply. Flap Grafts may consist of skin, subcutaneous tissues, muscle, bone or omentum.

What are the variants of Flap Grafts?

Flap Grafts can be classified as:

• Skin Flap Grafts - Skin Flaps or Skin Flap Grafts can be sub-divided in to 2 categories depending on whether they can be moved to a local (adjacent to the wound area) or distant (non-adjacent) graft site.
• Local Skin Flaps
• Random Pattern Skin Flaps - The blood supply for this kind of Skin Flaps comes from blood vessels in the dermis and below the dermis (musculocutaneous blood vessels). This method of Skin Flap Grafting is used for reconstruction of a facial defect.
• Rotational Skin Flaps - Those which rotate about in to the adjacent wound area to fill the defect.
• Transpositional Skin Flaps - This kind of Skin Flap is rectangular in shape and rotates to alternate it's position to cover the wound area.
• Advancement Skin Flaps - These Skin Flaps can be single pedicle, bipedicle or V-Y advancement.
• Z-plasty
• Rhomboid Skin Flaps
• Axial Pattern Skin Flaps - This kind of Skin Flap uses blood supply directly from a cutaneous artery and it's accompanying vein. It may have a pedicle which encourages the flap to increase its blood supply e.g. forehead flap supplied by superficial temporal artery.
• Myodermal, Myocutaneous or Musculocutaneous Skin Flaps - The blood supply for this kind of Skin Flaps comes from the underlying muscle as the skin and the underlying tissues including the muscle are all moved as a single unit. The musculocutaneous Skin Flaps can be:
  • Free Skin Flap - This kind of Skin Flaps are detached completely from it's blood supply and transferred to another part of the body where the blood supply would be re-established using Microvascular Surgery techniques e.g. free transverse rectus abdominis Skin Flap
  • Peninsular Skin Flap - Skin and Blood vessels are intact in the Skin Flap
  • Island Skin Flap - Blood vessel is intact but no skin in the pedicle of the Skin Flap
  • Distant Skin Flaps
  • Direct Skin Flap - A direct Skin Flap is transferred to a distant site directly so that the donor and recipient sites are brought close together. After 1 - 3 weeks the Skin Flap is freed completely.
  • Tube Pedicle Skin Flap - The tube Skin Flap is transferred to a recipient site with the lateral flap edges stitched together.
  • Microvascular Skin Flaps - In this type of Skin Flaps the blood vessels are completely detached from it's pedicle and anastomosed to the local blood vessels at the recipient site using Microvascular Surgery techniques.
  • Tissue Expansion Skin Flaps - Tissue expanders can be placed subcutaneously to expand adjacent skin prior to Skin Flap Grafting operation. The tissue expander can be inflated by filling it with saline. The expanded skin can be used for Skin Flap Grafting and the tissue expander removed after the procedure.
• Tendon Grafts - These are used to replace missing or non-functioning tendons
• Bone Grafts - They are used for the defects of facial bones, skull and long bones of the body
• Cartilage Grafts - This procedure is used to restore the cartilage of ear and nose
• Fascia, nerve, muscle, blood vessel, fat Grafts - These Grafts are used to restore the contour and defects in their respective tissues.

What are the factors that effect the outcome of Skin Flap Grafting?

Several factors play a key role in determining the success or failure of Skin Flap Grafting procedure, some of which include:

• Recipient site
• To ensure viability of the Skin Flap Graft, the recipient site should be evaluated carefully for color, texture, thickness and size of the wound area to be covered to achieve cosmetic objectives.
• To restore of the function of the affected part.
• Vigilant clinical observation to monitor the viability of Skin Flap. A healthy pink color and warm to touch are reliable pointers for clinical assessment of viability.
• Donor site
• Important factors to consider here are your overall health, smoking, any medical conditions like diabetes, hypertension, scarring due to previous surgical procedure(s), any past injuries, radiated tissue
• Skin Flap Graft
• Vascularity of Skin Flap
• Tension causing kinking or torsion (twisting) of the pedicle
• The elasticity and vascularity of Skin Flap
• Injuring the blood supply during dissection of the Skin Flap Graft from the donor site.

Benefits of Skin Flap Grafting

Wounds in areas of the body that are difficult to re-construct or repair like neck, front of the elbow or back of the knee are ideal places for Skin Flap Grafting as the Skin Flap Grafts in these areas will not contract and have a close match of skin color. Skin Flap Grafts are capable of sensation.

Risks of Skin Flap Grafting

• Failure of Skin Flap Grafting (rejection of the Skin Graft, infection or poor healing) and need for a repeat procedure.
• Hematoma or accumulation of blood underneath the Skin Flap Graft
• Weeping (oozing) of brownish, clear fluid or blood from the graft site
• Scarring
• Formation of necrotic tissue
• Hyperpigmentation
• Skin redness surrounding the graft site
• Pain and ulceration
• Distortion due to pulling away of Skin Graft

Alternatives to Skin Flap Grafting

Skin Grafting - Skin Grafting is a useful way to prevent infection and further progression of the wounds, such as diabetic ulcers, venous ulcers, pressure sores, after removal of skin tumor, Full Thickness Burns and deep lacerations. It is extremely crucial to match the color of the skin from the donor site to the recipient site (where skin would be transplanted to) to reduce the chances of a patchy appearance.

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