TRANSPLANTATION OF SKIN:

GRAFTS AND FLAPS

John Marquis Converse, Joseph
McCarthy, Raymond Braurer, Donald
Ballantyne
Anatomi Kulit
SKIN GRAFT
 • Nutritive material • Serum imbibition
• Metablolic waste • Revascularitation
• Anatomic distinction
• immunogenetic

Survival Phase

Necessary
Types
condition
• Well-vascularized bed • Asal
• Rapid Serum imbibition • Ketebalan
• Immobilitation
• Rapid Vascularitation
 Graft Healing Process

Serum Imbibition Revascularitation

• (24-48 hrs) • Inosculation (48hrs)

• Protein/fibrin layer acts as
glue to bind graft – wound
bed
• Diffusion of nutrients
from wound bed
• Priovide antibacterial
environment
• Oedema
• Increasing number of
vessel connecting (72 hrs)
• Vessel increasing in
functional strength and
full circulation (days 4-7)
• Lymphatic circulation
(days 5-6)
• Reinnervation 1st month
 Full Thickness Skin Graft

Advantages Usage Donor Site

• Contraction << • Face • Retroauricular

• Pigmentation << • Basal Cell Ca of • Supraclavicular
• Functional >> the face • Upper eyelid
• Cosmetics >> • Volar Aspect of • Abdomen
Hand & Finger • Thigh
• Other Site
• Preputial/labial
 Split Thickness Skin Graft

Storage Skin
Grafting Removal Donor Site
Graft
• Donor Site • Humby Knife • Prevent Scar • Above 0o in
• Cutting Instr • Dermatome Hypertrophy saline or
• Pressure • Mesh Graft serum
Dressing • Frozen State
(below 00)
 Failure of Take of Skin
Graft
• Bleeding & hematoma
beneath the graft
• External mechanical
factors
• Necrosis in bed
• Infection
 Behavior of STSG

Growth & • Primary

Contraction • Secondary

• Thin STSG >>

Color Changes • Donor below the neck >>

• Sweat gland; split vs thick STSG

Function of gland • Sebaceous: split = thick STSG
& innervation • Pilomotor & vasomotor: prolong
SKIN FLAP
 Vascular Anatomy

Segmental Perforator Cutaneus

• Arising from aorta • Connecting • Musculocutaneous

• Lying deep to the segmental and arteries
muscle mass cutaneus vessel • Direct Cutaneus
• Segmental pattern arteries
 Classification of Skin Flap

McGregor & Daniel & Microvascular

Morgan (1973) Williams (1973) Free Flap
• Random Flap • Cutaneus
• Axial Flap • Arterial
• Island
 Delay of Flap

Purpose Mechanism Optimum Time Types

• To condition • Outlined & • Area • Outline delay

the flap incised removed • Undermined
• Relative • Vessels • Age of
hypoxia increase in patient
state size &
number
• Direction
reoriented
in long axis
of flap
 PRINCIPLE OF FLAP SURGERY
• Design of the Flap
– Gillies (1932)
 PRINCIPLE OF FLAP SURGERY
• Location of Flap • Age of patient
– Local flap >> – Risk of arterioscclerotic
– Scars << changes
– Head – neck >>
– Should not be designed
so that the midline is
transgressed
 PRINCIPLE OF FLAP SURGERY
• Mechanical factors
– Suturing under excessive
tension
– Gravity
– Kinking
– Pressure
– Hematoma
 TIPE FLAP
Random Flap Axial Pattern Flap
• Advancement flap • Island flap
• Transposition flap • Myocutaneus
• Tube Flap • Microvascular free flap
• Flap from distance
 Random Pattern Flap
Advancement Flap
Transposition Flap Rtational Flap
Tube Flap
Direct Flap from Distance
Axial Pattern Flap Microvascular free fla[
 Suitability of Skin Graft & Flap
• Skin Graft Unsuitable For
• Dense scarred area
• Bone
• Tendon
• Peripheral nerve surgery
• When secondary operation are necessary in
the rapaired area
 Failure in Flap Transfer
• Necrosis
• Infection
• Improper Postoperative Care
THANK YOU