Plastic Surgery Essentials for Students-Chapter 6: Grafts and Flaps

Chapter 6: Grafts and Flaps

Pdf Summary

Chapter 6, titled "Grafts and Flaps" by Chad A. Purnell, MD, and Ash Patel, MBChB, FACS, delves into the medical techniques for reconstructing deformities that cannot be closed primarily, where secondary healing would be inadequate. The chapter begins by explaining grafts, which are tissues transplanted without their own blood supply, requiring a healthy wound bed capable of supporting angiogenesis for survival. Specific types of skin grafts are highlighted, including full thickness skin grafts (FTSGs) and split thickness skin grafts (STSGs), each with distinct donor site considerations and healing characteristics.<br /><br />The mechanisms for skin graft survival are discussed, including plasmatic imbibition, inosculation, and angiogenesis, along with the failure mechanisms such as poor wound bed, shear forces, hematomas, seromas, and infection. Skin substitutes, like allografts, xenografts, and synthetic options, offer temporary solutions or support for other reconstructive treatments.<br /><br />The chapter proceeds to discuss other graft types, such as nerve, fat, tendon, cartilage, bone, muscle, and composite grafts.<br /><br />Flaps, distinguished from grafts by their intact vascular supply, are introduced as essential for complex or large reconstructions and situations where the wound bed is unfit for grafts. Flaps are classified by tissue type (single or multiple components), location (local, regional, distant), and vascular pattern (random vs. axial, pedicled vs. free, and perforator flaps).<br /><br />The criteria for choosing the right flap involve evaluating the primary defect, such as its size, location, required tissue type, and functional or aesthetic demands, along with secondary donor site considerations in accordance with the angiosome. The success of flaps depends on appropriate vascularity and achieving reconstruction goals, with potential failure from tension, pedicle kinking, compression, thrombosis, or infection.

Keywords

grafts

flaps

skin grafts

angiogenesis

reconstructive surgery

vascular supply

donor site

tissue transplantation

wound healing

reconstruction techniques