What is the difference between a full-thickness skin graft and a skin flap?

Question

In terms of procedure, healing, purposes, aesthetic outcome, etc. Thanks.

Soheila Rostami, MD, FAAO, FAACS · Answer

the difference between a graft and flap is that one is free and the other one has a pedicle attached to its original place. The graft needs the area blood supply to survive but the flap has its own blood supply. The full thickness graft, has the subcutaneous fat and muscles with the skin graft. We worry about strangulation of blood supply in the flap. When we planing the movement of the flap, we should consider the blood supply of the flap as well.

David W. Rodwell III, MD · Answer

Dr. Harris gave a good review of the defining characteristics that differentiate a full thickness skin graft from a skin flap.Keep in mind that the term skin flap encompasses a huge variety of options.  There is also some variability in the ways to perform a full thickness skin graft but not nearly as much variation when it comes to flap options.To further answer your question I'll touch on each of the points you asked about:1. ProcedureAs mentioned and in the most general terms, a GRAFT is separated from the body and reattached while a FLAP maintains a partial connection to its blood supply and is then used to close a defect.A full thickness skin graft is overall a much more simple procedure in terms of complexity.  Skin "flaps" range from very simple and straightforward to some very intricate complex options depending on the defect needing to be closed and its location.2. HealingBoth options typically heal well.  A skin flap has a much better rate of graft take or survival because of its inherent better blood supply.  Issues like having diabetes, being a smoker, or having peripheral vascular disease will greatly increase the potential for poor healing with a full thickness skin graft (or a skin flap for that matter).3. PurposesBoth are good options -- it really depends on what the defect is and where it is located.  A full thickness skin graft is a less complex option which can be used to keep things simple and avoid a longer more complex procedure.  Some of the decision making also comes down to aesthetics.4. Aesthetic OutcomeSometimes a skin flap is preferred, not only because of better blood supply, but also because the skin adjacent to a defect that is being rotated in is usually a very good color and texture match.  However, full thickness grafts taken from certain areas can match very well to specific defect areas.Sometimes a full thickness graft will have a higher rate of scar contracture.  With both types of procedures you can get other issues related to swelling that we call trap door deformities or pin cushioning.Overall, a flap is a better aesthetic option for the majority of defects in my opinion, but I continue to use full thickness grafts in certain situations when indicated and the aesthetic results can be very good.

Stephen Weber MD, FACS · Answer

A skin graft is a free piece of skin that is excised, removed and thinned before being inset into a wound whereas a flap is tissue around a wound that is rearranged and positioned to fill a defect in the local area. Both work great when used appropriately. If you have a skin cancer surgery coming up discuss with your dermatologist or your plastic surgeon if you've been referred to another doc for Mohs reconstruction. I hope this information is helpful for you.Stephen Weber MD, FACSDenver Facial Plastic Surgeon

Matheson A. Harris, MD · Answer

A full thickness skin graft is a piece of skin (including the outer epidermis and complete underlying dermis), which is taken from one location and placed in a separate location. It is separated from its natural blood supply and must be placed on a recipient site with an active blood supply. A skin flap is partially dissected free of the underlying tissue, but a portion of it is left attached to the blood supply. Skin flaps are usually pulled into a skin defect (advancement flap) or rotated (rotational flap). They can be used in an area where the blood supply is poor because they bring their own blood supply with them, such as over bone.

R. Stephen Mulholland, MD (retired) · Answer

Dear eyelid123,

A full-thickness skin graft is a piece of skin, including the
epidermis and dermis, that is removed from its vascularized bed and de-vascularized
in place on a viable surface, where a new blood supply must be picked up and a
nutrient blood supply returned to the graft. 
Generally, skin grafts undergo contraction over time; full-thickness
skin grafts less so than split-thickness skin grafts.  In general, skin grafts need to be selected
carefully for their match in colour, texture and thickness.  A skin flap, however, is not devoid of its
blood supply. It is rotated, transposed
or inserted with its blood supply intact or can even be transplanted with blood
vessels re-anastomosed to the local site. In general, vascular skin flaps do
not contract, have a more natural and pliable consistency to their texture and,
for upper lid reconstruction, are usually transferred from the lower lid or
from localized, vascularized tissue. This kind of reconstruction requires a
very specialized skill set and you should seek out the advice of surgeons who
perform vascularized and non-vascularized flaps and grafts to eyelid
reconstruction.  The Sunnybrook Hospital
has some excellent plastic surgeons that do vascularized and non-vascularized
reconstruction of the eyelid.  Dr. Jeff
Fialkov is one of those physicians, as is Dr. Oley Antonyshyn.

I hope this information has been of some assistance and best
of luck.

Sincerely,

R. Stephen Mulholland, M.D.

Certified Plastic Surgeon

Yorkville, Toronto

What is the difference between a full-thickness skin graft and a skin flap?

Answers (5)

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