Skin Grafting & Flap Surgery

Skin Grafting & Flap Surgery

Skin grafting is a type of medical grafting involving the transplantation of skin. The transplanted tissue is called a skin graft.

Skin grafting is often used to treat:

  • Extensive wounding or trauma
  • Burns
  • Areas of extensive skin loss due to infection such as necrotizing fasciitis or purpura fulminans
  • Specific surgeries that may require skin grafts for healing to occur – most commonly removal of skin cancers.

Skin grafts are often employed after serious injuries when some of the body’s skin is damaged. Surgical removal (excision or debridement) of the damaged skin is followed by skin grafting. The grafting serves two purposes: it can reduce the course of treatment needed (and time in the hospital), and it can improve the function and appearance of the area of the body which receives the skin graft.

There are two types of skin grafts, the more common type is where a thin layer is removed from a healthy part of the body (the donor section), like peeling a potato, or a full thickness skin graft, which involves pitching and cutting skin away from the donor section. A full thickness skin graft is more risky, in terms of the body accepting the skin, yet it leaves only a scar line on the donor section, similar to a Cesarean section scar. For full thickness skin grafts, the donor section will often heal much more quickly than the injury and is less painful than a partial thickness skin graft.

Flap Surgery

Flap surgery is a piece of tissue that is still attached to the body by a major artery and vein or at its base. This piece of tissue with its attached blood supply is used in reconstructive surgery by being set into a recipient site (injured area onto which a flap or graft is placed). Sometimes, the flap is comprised of skin and fatty tissue only, but a flap may also include muscle from the donor site (the area from which the flap is raised).

Who Might Need Flap Surgery?
If you have suffered tissue loss over any area of your body, you may be a candidate for flap surgery. This type of reconstructive plastic surgery is typically used to repair defects left behind after traumatic injury or mastectomy. Flap techniques can also produce excellent results in facial reconstruction after skin cancer excision.(Mohs surgery).

There are as many types of flaps as there are types of injuries which might require the use of a flap. Flaps come from many different locations, and are used in many different ways to accomplish the desired result. However, flaps used for reconstructive plastic surgery can be broken down into two main categories.

Local (Pedicled) Flap:
Tissue is freed and rotated or moved in some manner from an adjacent area to cover the defect, yet remains attached to the body at its base and has blood vessels that enter into the flap from the donor site. The type of flap movement required determines which of the four main types of local flaps is used.

The four major types of local flaps include the advancement flap (moves directly forward with no lateral movement), the rotation flap (rotates around a pivot point to be positioned into an adjacent defect), the transposition flap (moves laterally in relation to a pivot point to be positioned into an adjacent defect) and the interpolation flap.

The interpolation flap is different from the others in that it rotates around a pivot point to be positioned into a nearby (but not adjacent) defect. The result is that a portion of the flap passes above or below a section of intact tissue, forming a sort of “skin bridge.” This type of flap is intended to be sectioned (separated) from the donor site in a subsequent procedure.

Free Flap:
Tissue from another area of the body is detached and transplanted to the recipient site and the blood supply is surgically reconnected to blood vessels adjacent to the wound.