Physical therapy post-skin graft and flap

Skin flap
• A flap is a unit of vascularized tissue that may be transferred from one apart of the body
to another.
• It is more simply defined as specific tissue that is mobilized on the basis on its vascular
anatomy.
• A flap ay contains a single tissue (skin, muscle, fascia, fat, bone, tendon, nerve) or a
combination of tissue.
• Because of the thickness and/or composite nature of flaps, the tissue being transferred
cannot initially survive by diffusion from the recipient bed; it is must have its own inflow
and outflow of blood.

• A flap is termed pedicle if it maintains its blood vessels continuity at all times and is raised
and/or transposed on the pedicle, it is termed free flap if the vein and artery of the
pedicle are cut and re-anastomosed to other blood vessels.

Classification

➢ According to vascular supply ➢ According to composition

1- random flap: - 1- single tissue
This concept is only applied to skin 2- composition of tissue.
2- axial flap:
Based on longitudinal vessels along the 1-adanement flap: no rotation
pathway of the flap. 2- rotational flap: rotation
3- musculocutaneous: -
Involves a combination of skin and muscles. The
vascular pedicles supply a muscle, which at the
same time provides perforator branches to the
skin
4- fasiocutaneous:
Once the artery reaches the fascia, it gives
perforator branches to the skin.

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Skin graft
• A skin graft contrary to flap does not need to avascular pedicle to ensure its survival.
• Skin graft is composed of epidermis as well as a variable amount of dermis.

• Skin graft is something that is removed from the body, is completely devasculraised, and
is replaced in another location.
• Skin graft can be defined as epidermis and a proportion of dermis completely separated
from its donor site that is transferred to a distant recipient bed.
➢ According to thickness: - ➢ According to origin
1- full thickness skin graft (FTSG): 1- autograft:
entire dermis and epidermis if the donor and recipient of the graft are
the same individual.
2- split thickness skin graft (STSG): 2- isograft: if graft is exchanged between
epidermis + fraction of dermis two identical twins.
3- allograft: when the donor and the
recipient are two different individuals but
from the same species.
4- Xenograft: if a graft I exchanged between
two different species

phases of skin graft

1- imbibation:
Graft survives by diffusion of nutrient from the wound bed.
Fibrin deposition
2- neovascularization
3- maturation
Post-grafting program
1- immobilization:
For 5 days
No ROM of joints which new graft crosses
Bloster dressing: to maintain close contact of the graft the recipient bed and to protect it from
trauma.
NPWT: 75 mmhg
Splinting
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Edema control
• Elevation
• Compression
Exercises
1- static exercises: during imbibition phase to increase muscle pumping.
2- isometric exercises start at 2nd week and continue to 2 weeks
3- dynamic exercise: start at 3rd week

Stretching exercise
At maturation phase to prevent contractures

ROM exercises:
Passive ROM after 7 days
To prevent joint stiffness

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