RECONSTRUCTIVE

MODALITIES
RECONSTRUCTIVE PROCEDURES

SKIN GRAFTING FLAPS

SKIN GRAFTING
 SKIN GRAFTING
SURGICAL TECHNIQUE IN WHICH A

SECTION OF SKIN IS DETACHED FROM ITS OWN

BLOOD SUPPLY AND IS TRANSFERRED AS FREE

TISSUE TO RECIPIENT SITE

 INDICATIONS

• EXTENSIVE TRAUMA

• BURNS

• SURGERIES

• AREAS WITH PRIOR INFECTION LEADING TO

SKIN LOSS

• COSMETIC REASONS
 CLASSIFICATION
• BASED ON THE SOURCE OF GRAFT :

- AUTOGRAFT

- ALLOGRAFT

- XENOGRAFT
• BASED ON THICKNESS OF GRAFT :
- SPLIT SKIN GRAFT – HERE THE SURFACE
LAYERS ( EPIDERMIS AND UPPER DERMIS) ARE
SHAVED OUT WITH SSG KNIFE
- FULL THICKNESS GRAFT – CONSISTS OF
EPIDERMIS AND ENTIRE DERMIS, WITHOUT
UNDERLYING FAT
- COMPOSITE GRAFT – COMBINATION OF
SKIN AND FAT OR CARTILAGE USED FOR THREE
DIMENSIONAL RECONSTRUCTION
DONOR SITE
• BUTTOCKS, THIGHS, UPPER ARM
• 1 – 2 WEEKS DRESSING
• REGULAR PAINKILLERS
• PROTECT FROM EXTERNAL ENVIRONMENT
• CLEAN DRY DRESSING
• SELECTED BASED ON :
- CLOSEST COLOR MATCH
- MATCHING TEXTURE, HAIR DISTRIBUTION
- THICKEST POSSIBLE ONE
- COSMETIC ASPECTS OF DONOR
GRAFT APPLICATION
• DONOR SITE PREPARATION AND PATTERNING

• HARVESTING – SCALPEL/ DERMATOME OR

KNIFE

• MESHING AND PLACEMENT

• SUTURING THE GRAFT

• PRESSURE BANDAGING/ VAC

 HEALING OF GRAFT

• PLASMATIC IMBIBITION

• CAPILLARY INOSCULATION

• NEW SKIN DEVELOPMENT

• TAKING THE GRAFT

 AFTERCARE

• LUBRICATION OF GRAFT WITH VASELIN OR OIL

• ANTIHISTAMINES

• PERSONAL HYGEINE

• COTTON CLOTHES

• AVOID SITE BEING TOO DRY AND FLAKY

• SUNLIGHT PROTECTION
SKIN FLAPS
 SKIN FLAPS

A FLAP IS A SEGMENT OF TISSUE THAT

REMAINS ATTACHED AT ONE END (A BASE OR A

PEDICLE) WHILE THE OTHER END IS MOVED TO

THE RECIPIENT AREA

 ADVANTAGES

• PROVIDE BULKNESS OVER THE DEECT

• OFFER AESTHETIC SOLUTION SINCE FLAP

RETAINS COLOR AND TEXTURE

 INDICATIONS
• CONGENITAL DEFORMITY, TRAUMA OR
TUMOR ABLATION

• EXTENSIVE WOUNDS FROM PRESSURE ULCER

• LONG STANDING DEFECTS OF OSTEOMYELITIS

• COSMETIC REQUIREMENTS OF WOUND

COVERAGE
 FREE FLAPS

FLAPS WHICH ARE HARVESTED FROM ONE

PART OF THE BODY BY DETACHING FROM ITS

BLOOD SUPPLY AND IS REATTACHED BY

MICROVASCULAR ANASTOMOSIS TO ARTERIES

AND VEINS AT THE RECIPIENT SITE

 TYPES OF SKIN FLAPS
• LOCAL – DEFECTS ADJACENT TO DONOR SITE

• DISTANT – DEFECTS ARE PRESENT IN A

DISTANT SITE
 LOCAL FLAPS

a. ADVANCEMENT FLAP

b. ROTATIONAL FLAP

c. TRANSPOSITION FLAP

d. INTERPOLATION FLAP
 ADVANCEMENT FLAP

FLAP MOVES DIRECTLY FORWARD

WITHOUT LATERAL MOVEMENT
 ROTATIONAL FLAP
A SEMICIRCULAR FLAP THAT ROTATES

ABOUT A PIVOT POINT INTO AN ADJACENT

DEFECT
 TRANSPOSITION FLAP

A FLAP THAT MOVES LATERALLY ABOUT A

PIVOT POINT INTO AN ADJACENT DEFECT

 INTERPOLATION FLAP

ROTATES ABOUT A PIVOT POINT INTO A

NEARBY BUT NOT ADJACENT DEFECT, WIT

PEDICLE PASSING OVER A SKIN BRIDGE

 DISTANT FLAPS
a. DIRECT FLAP

b. TUBED FLAP

c. MICROVASCULAR FREE FLAP

 DIRECT FLAP
DIRECT FLAPS INVOLVE HAVING THE FLAP
CONNECTED TO BOTH THE DONOR AND
RECIPIENT SITES SIMULTANEOUSLY, FORMING A
BRIDGE. THIS ALLOWS BLOOD TO BE SUPPLIED
BY THE DONOR SITE WHILE A NEW BLOOD
SUPPLY FROM THE RECIPIENT SITE IS FORMED.
ONCE THIS HAPPENS, THE "BRIDGE" CAN BE
DISCONNECTED FROM THE DONOR SITE
 TUBED FLAP

FLAP TRANSFERRED TO RECIPIENT SITE

WITH LATERAL EDGES SEWN TOGETHER, WHILE

NEW BLOOD SUPPLY INCORPORATE INTO FLAP