Grafts and flaps are procedures that transfer good tissues to areas that have lost their skin. They are widely used in closing skin cancer surgeries or in burns.
“Flap” is the skin and subcutaneous segment with its own vascular supply, which will be moved from one area (donor) to another (recipient), in order to fill a surgical wound. There is communication between the flap and the donor area through a pedicle, which will ensure its survival.
When a surgical wound is created by removing a skin tumor, the first step is to try to close it with approximation and primary closure of the edges. If the defect created by the surgical wound is very large, the edges cannot be approached and there is a need to make a flap or skin graft. The reconstruction can be performed during the surgery itself or left for a second moment, if the patient’s clinical conditions are not favorable.
On average, up to seven days are allowed for a flap. However, the recipient bed must be prepared, reviving the wound edges and reducing the granulation tissue.
Some conditions are necessary to perform a flap. The skin type and the donor region must have leftovers and mobility, so that the flap reaches the recipient area without traction or vascular suffering in its pedicle. In addition, the new ulcerated area created by the donation of skin (secondary defect) should allow a primary closure without difficulties.
A graft, on the other hand, is a piece of skin removed from a body area – the donor area – and transferred to another area, the recipient, without any communication pedicle between them. Only later does it develop its own vascularization, thus re-establishing a new blood supply.
Grafts can be classified as follows:
- Total skin graft: characterized by the presence of the epidermis and the total thickness of the dermis.
- Partial skin graft: it is characterized by the preservation of the dermis in the donor area, thus enabling its reepithelization, through the epithelial cells from the pilosebaceous systems and the sweat glands remaining in the donor area.
- Composite grafts: consist of an intact portion containing the entire epidermis and the dermis, with an additional fat or cartilage component. Ex: chondrocutaneous graft (skin connected to one side of the cartilage), chondrobicutaneous graft (skin connected to both sides of the cartilage), dermo-fat graft (dermis with fatty tissue).
- Autograft: when the donor and the recipient are the same individual.
- Homograft or allograft: when the donor and the recipient are different individuals, but of the same species. Ex: biological dressing (used temporarily).
- Iograft: when the donor and the recipient are different individuals, but genetically identical. Ex: twin twins.
- Xenograft: when the donor and the recipient are individuals of different species. Ex: biological dressing (pig skin used in humans).
