Plastic and Reconstructive Surgery

Large skin defects can result from car accidents, bite wounds, lacerations, infections, burns, or surgical removal of benign or malignant cancerous masses. Closure of these defects is often limited by the location of the defect as well as the availability of healthy surrounding tissue.

Methods to close large defects include primary closure, skin flaps, and free grafts.
1. Primary closure consists of apposing surrounding tissues directly together with sutures. Examples include: simple sutures, adjacent tissue advancement, releasing incisions, and “Y” and “Z” plasty.

2. Skin flaps are partially detached segments of skin that maintain their blood supply at the base. Once advanced or rotated, these flaps cover the wound and offer immediate blood supply and full thickness skin coverage. These grafts are limited by the distance from the supplying blood vessel. Examples include: axial pattern flaps, pouch flap, reverse conduit flaps.

3. Free grafts are completely detached segments that are transferred to cover a distant defect but lack a blood supply. Blood vessels from the wound bed grow into the graft to become its permanent blood supply. These grafts may be used almost anywhere on the body. Examples include: mesh grafts, pinch grafts, punch grafts.