Skin graft

Skin graft implies that skin is severed from its blood supply and applied to another area. If the skin graft is to survive, it must absorb its metabolic requirements by interfacing directly with the underlying tissue. Skin grafting is often used to cover exposed muscle and where the vascularity of the underlying tissue is good, infection is absent and hemostasis is achieved. Leech therapy is not usually indicated for skin grafting because skin grafts do not have intact blood vessels and therefore do not become congested.

Types of Skin Grafts
Split Thickness Skin Graft
  • Epidermis and some dermis
    • No: sensation, hair, circulation, sweat or sebaceous glands.
  • Graft absorbs nutrients from recipient bed until vessels grow into graft.
  • Requires direct contact with recipient bed; pooled fluid can lift the graft, causing ischemia and failure.
Full thickness Skin Graft FTSG
  • Contains epidermis and all of the dermis, including: hair, sweat and sebaceous glands, pacinian corpuscles along with fascia and subQ. Fascia and subQ will be removed to improve "take."
  • No circulation, graft obtains nutrients by absorption, vessels grow into graft from recipient bed. Requires direct contact with recipient bed, fluid can lift graft, causing failure.
  • More durable, more normal function than STSG, sensation may return over time.

Skin flaps

Thanks to microsurgical technique, reconstructive surgeons regularly harvest, transfer, transplant and reattach flaps of tissue with supporting vasculature intact. In fact, not long ago the first successful transplant of a human face was accomplished. Flaps may be:

They may be mobilized and rotated to an adjacent position (advancement & rotational) or severed and transferred (free flap) to another area. Because flaps consist of intact layers of tissue and blood supply they are less likely than skin grafts to contract or become infected. Skin flaps are used to cover and insulate exposed bone, tendon and nerve and to reconstruct excised structures.

Flaps are robust compared to skin grafts, but they are subject to failure due to vascular occlusion. Clots and emboli formed at arterial or venous anastomoses, vasoconstriction, edema and torsion, all may lead to flap ischemia. In the event of non-operable venous obstruction, combined with venous congestion, surgeons may choose leech therapy as an adjunct treatment to salvage the tissue flap.

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