Plastic Surgery

To do list:
difference between graft and flap.
Plastic Surgery
From the Greek plassein means to mold.
It is a branch in surgery that involves using various techniques to restore the form and the
functions of the body when the tissues have been damaged by injury, Ca, congenital.
Grafts: tissue transferred without its blood supply.
1. Split-thickness skin grafts STSG
2. Full-thickness skin grafts ( FTSG )
3. Composite skin grafts ( CSG )
4. Nerve grafts ( usually sural nerve )
5. Tendon grafts ( usually from Palmaris longus or plantaris tendon )


SKIN GRAFTS
are segments of epidermis and dermis that have been detached from their native blood
supply to be transplanted to another area of the body.
CONTRAINDICATIONS :
covering exposed tendon, cartilage, or cortical bone.
FACTORS DETERMINE SKIN GRAFT CONTRACTURE :
1. Thickness of taken dermis with the graft
2. Level of post- op splinting
3. Physiotherapy applied to the grafted site
TYPES:
Skin grafts are classified according to origin, thickness, tissue type.
1. According to origin:
a. Autograft (i.e., from the same person),
b. Allograft (i.e., from a genetically dissimilar individual of the same species,
usually a cadaver
c. Xenograft (i.e., from a different species, usually pigs).
d. Cultured skin can be grown from human epidermal cells; this skin is most
useful for extensively burned patients because more surface area can be
covered; however, the cultured skin tends to be very thin.
2. According to thickness:
a. Split-thickness skin grafts STSG:
- Contain the epidermis and a portion of the dermis.
- Used to cover all sizes of wounds.
- Common donor sites the abdomen, buttocks, and thighs
- They are further divided according to the amount of dermis
included in the graft into:
1. Thin:
donor site : heals better, more bleeding points, no
brisk bleeding.
Graft : more contracture , less durable
hairless , do not sweat.
2. Medium
3. Thick:
donor site : more difficult healing , less bleeding pints,
brisker bleeding.
Graft : less contracture, more durable
b. Full-thickness skin grafts ( FTSG )
- require the best handling and poet-op care.
- Contain the epidermis and the full thickness of dermis without
subcutaneous fat.
- They are most useful for covering defects on the face or hand that
are not amenable to coverage with a skin flap (see I C).
- Donor sites:
A good match of skin color can be obtained donor sites in
the postauricular or supraclavicular areas.
Preauricular grafts provide the best color match for the
face.
The forearm and groin can also serve as donor sites for
defects below the clavicle.
- Advantages of full-thickness skin grafts include:
Cosmetic superiority to split-thickness skin grafts
Decreased secondary contractures (grafts may be cut as
required to fill the defect)
Increased durability
- Disadvantages of full-thickness skin grafts include:
Limited donor sites
Increased primary contracture
Used for smaller areas than STSG.
c. Composite skin grafts
- FTSG + S\C fat + catrilage.
-
- Formed of multiple tissues (e.g., a fingertip containing skin,
subcutaneous fat, and bone or a segment of ear containing skin
and cartilage).
- Effective in:
Young patients.
Situations where the distal portion of the graft is
less than 1 cm from the blood supply.
Reasons of graft failure:
1. hematoma
2. seroma
3. infection
4. shearing forces
5. poor blood supply


Flap : tissue transferred with its own blood supply.
Flaps may be classified according to:
1. type of tissue contained in the flap
i. fasciocutaneous
ii. musculocutaneous
iii. osteocutaneous
2. their design and method of transfer baily 402
i. advancement
ii. rotation
iii. transposition
iv. Z-plasty
v. bilobed flap
vi. rhomboid
vii. V-Y
viii. bipedicled
3. the source of their blood supply:
i. random :
these rely on the low perfusion pressures found in the subdermal
plexus to sustain the flap and not a named blood vessel.
Consist of three sides of a triangle that bears no specific relationship
to where the blood supply enters.
Length to breadth ratio is no more than 1.5:2, but can be
lengthened by delaying the flap ( partial cuts and partial elevation of
the flap on one operation the complete the cuts and the elevation
on another operation ).

ii. Axial
these rely on a known blood vessels
Consist of three sides of a triangle that bears specific relationship to
where the blood supply enters.
Length to breadth ratio is no more than random flaps
iii. free:
isolated blood supply , then microsurgery.



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