SKIN INCISIONS

SKIN CLOSURE,
GRAFTS, AND FLAPS
 SKIN GRAFTS
• Skin graft – sheet
of skin including
epidermis and
dermis that is
completely freed
from its native
blood supply and
transplanted to a
recipient site to
be closed.
 SKIN GRAFTS
• Partial (split) thickness:
– some level with dermis
– 1/1200 to 1/2000 of an inch

• Full thickness:
– including all epidermis and dermis

• Composite graft:
– free graft containing at least two different
tissue elements
– skin and cartilage
 TYPES OF SKIN GRAFTS:
Split-thickness skin grafts
• Advantages:
– Grafts ‘take’ more readily
– Donor site heals more readily, allowing
secondary harvesting at an earlier date
– Recipient site contracts to a greater
degree, limiting the size of the graft
(advantageous if not overlie a joint)
 TYPES OF SKIN GRAFTS:
Split-thickness skin grafts
• Disadvantages:
– Color and texture of grafted skin are not
well maintained
– Grafts are less likely to have normal
sebaceous activity and sweating
– Hair is not transferred with the graft
– Grafts in children will not grow as the child
grows
 TYPES OF SKIN GRAFTS:
Full-thickness skin grafts
• Advantages:
– Color and texture of grafted skin are
optimally maintained
– More normal sweating and sebaceous
activity maintained
– Contraction at recipient site is limited
(important when overlie a joint)
– Hair is transferred with the graft
– Grafts in children will grow as the child
grows
 TYPES OF SKIN GRAFTS:
Full-thickness skin grafts
• Disadvantages:
– Grafts require careful care to ensure ‘take’
– Donor sites will not heal secondarily and
require separate closure
 TYPES OF SKIN GRAFTS:
Meshed grafts
• Advantages:
– Grafts can be expanded to cover larger
areas
– Interstices prevent blood and serum from
accumulating under the graft and limiting
‘take’
– Grafts may contour better to irregular
recipient sites
 TYPES OF SKIN GRAFTS:
Meshed grafts
• Disadvantages:
– Graft appearance is ‘cobblestoned’ and
less aesthetic
– Recipient site may contract to a greater
degree (contractures over joints)
• General principles:
–well-vascularized
recipient bed
–meticulous technique
 Skin flaps:
l FLAPS:
l a tongue of tissue transferred from one anatomic
site to another
l vascularity of transferred tissue is maintained
 Classification of flaps:
Blood supply • Random flap
Random flap – receives blood through the
Axial flap dermal and subdermal
plexus

• Axial pattern flap

– cutaneous arteries and
veins longitudinally
oriented within the
substance of the flap
 Classification of flaps:
Blood supply
Random flap
Axial flap
 Classification of flaps:
Blood supply
Random flap
Axial flap
 Classification of flaps:
• Fasciocutaneous flap
• Tissue composition – skin and underlying
fascia, supplied by
Cutaneous flap vascular plexus within
Fasciocutaneous the fascia
flap • Musculocutaneous
flap
Musculocutaneous
skin, fascia, muscle;
flap
–
supplied by perforating
Muscle flap vessels from the
muscle to the
Osteocutaneous subdermal plexus
flap
Osseous flap
 Classification of flaps:
• Transfer method
Advancement flap
Single pedicle advancement flap
V-Y, Y-V flap
Bipedicle flap
 Classification of flaps:
• Transfer method
Pivot flap
Rotation flap
Transposition flap
Simple transposition flap
Bilobed flap
Rhomboid flap
Z-plasty
Interpolation/island flap
 Classification of flaps:
• Transfer method
Distant
Direct flap, e.g., crossleg flap
Tubed pedicle
Free flap
Classification of flaps:
Classification of flaps:
Classification of flaps:
Classification of flaps: