PRINCIPLES OF

PLASTIC SURGERY

SKIN GRAFTS
AND
FLAPS
OSCAR V.A. TAGULINAO, M.D., FPCS, FPAPS
SECTION OF PLASTIC SURGERY, DEPARTMENT OF SURGERY
UNIVERSITY OF SANTO TOMAS
CARDINAL SANTOS MEDICAL CENTER
LINES OF LANGERS

Animation

Gravity

Inconspicuous
scar
 WOUND HEALING
1. INFLAMMATORY PHASE
Humoral phase
Cellular phase
2. EPITHELIALIZATION
3. COLLAGEN FORMATION
4. SCAR MATURATION
 INFLAMMATION PHASE
• HUMORAL PHASE
– Histamine from mast cells, granulocytes &
platelets – vasodilatation & permeability
– Kinins & prostaglandins

• CELLULAR PHASE
– Polymorphonuclears, monocytes, fibrinous
material
EPITHELIALIZATION
EPITHELIALIZATION is
complete after 48 hrs in a
sutured wound
CORRECT WRONG
 COLLAGEN FORMATION
• 3rd day – spindle-shaped cells
HEALING BY SECONDARY INTENTION
WOUND CONTRACTION
 WOUND CONTRACTION
• Centripetal advance of wound edge
• Myofibroblasts, Marjolin’s Ulcer
 SCAR
CONTRACTURE
Hypertrophic
Keloid
HOW TO MINIMIZE
SCARRING
• Debride all devitalized tissues
• Remove foreign bodies
• Close primarily
• Handle tissues gently
• Prevent infection
 KINDS OF GRAFTS
Split thickness
graft
epidermis & upper third of
dermis
thin
epidermis & upper half of
thick dermis

Full thickness graft

epidermis & entire dermis
 CHARACTERISTICS OF
GRAFTS
1.thin grafts contract more
2.thin grafts may change
color
3.thick grafts will grow hair
4.sensation follows
recipient
GRAFT REQUIREMENTS

1.vascular recipient bed

2.contact between graft &
recipient
3.immobilization of graft
4.free from infection
SPLIT THICKNESS GRAFTS
FULL THICKNESS GRAFTS
PROBLEMS WITH GRAFT
Lacks tissue bulk
PROBLEMS WITH GRAFT
contracts may grow hair
Grafts will not survive on
avascular recipient sites
 KINDS OF FLAPS
1.Skin flaps
2.Muscle flap
3.Compound flap
•Fasciocutaneous flap
•Musculocutaneous flap
•Osseocutaneous
 KINDS OF SKIN FLAPS:
BLOOD SUPPLY
Random flaps
Subdermal plexus of capillaries

Arterialized flaps
Artery runs along the length
of flap
 KINDS OF SKIN
FLAPS: FLAP SOURCE
Local flaps
Advancement flaps, rotation
flaps, interpolation flaps
Distant flaps
Crane flaps, waltzing flaps,
free flaps
CHARACTERISTICS OF FLAP
1. has own blood supply
2. thick and has bulk
3. contracts less than grafts
4. retains characteristics of donor
area
5. maybe used in avascular
recipient sites
RANDOM FLAPS
ARTERIALIZED FLAPS
ARTERIALIZED FLAPS
LOCAL FLAPS
Advancement
flap
LOCAL FLAP
Rotation flap
LOCAL FLAP
Interpolation
flap
V-Y
advancement
flap brings
tissue to
defect
Z-plasty
rearranges
tissues to
add length
or fill in a
depressed
area.
 A
A

B
B
A B A

B
Multiple
Z-plasties
add more
length and
change the
direction of
the scars.
 Z-
plasty
 Z-
plasty
DISTANT FLAPS
Groin flap
DISTANT

FLAPS
MUSCLE FLAPS
Soleus
muscle

skin graft
MUSCULOCUTANEOUS FLAPS
• skin, subcutaneous tissue
and muscle
• perforating arteries from
the muscle
• maybe used as free flap
with vascular pedicle
MUSCULOCUTANEOUS FLAP
Latissimus dorsii
MC FLAP
Biceps
femoris
MC FLAP

Free flap
GRAFTS
AND
FLAPS