Skin Grafts & Flaps
Skin grafts and flaps are reconstructive techniques used to repair tissue defects from trauma, skin cancer excision, burns, or chronic wounds where the wound cannot be closed directly or healed adequately on its own. The goal is to restore tissue coverage, protect underlying structures, and achieve the best possible functional and aesthetic outcome.
Skin Grafts
A skin graft is skin removed from a donor site and transferred to a wound, where it must develop a new blood supply to survive. Two types are used:
Split-thickness grafts (STSG): Include the epidermis and a partial dermis. More reliable take, particularly over large or poorly vascular wounds, but with greater contraction and poorer cosmetic result. The donor site heals over ten to fourteen days.
Full-thickness grafts (FTSG): Include the full dermis. Better colour and texture match, less contraction, superior cosmetic outcome. Donor site is sutured closed. Preferred for facial and hand defects.
After placement, grafts are immobilised with a tie-over bolster dressing for five to seven days while blood vessels grow. Graft maturation takes six to twelve months.
Flaps
A flap transfers tissue with its own blood supply intact, allowing immediate survival and making it suitable for wounds with poor vascularity or exposed bone, tendon, or nerves. Flaps are classified by movement (advancement, rotation, transposition) and tissue type (skin, fasciocutaneous, musculocutaneous, bone). Local flaps from adjacent tissue provide the best colour and texture match. Regional and free flaps bring tissue from more distant areas and are described in the Complex Reconstruction section.
Your Recovery
Skin graft recovery requires immobilisation for five to seven days. After graft take is confirmed, gradual mobilisation begins. Grafted areas may contract and develop hypertrophic scarring, requiring pressure garments and scar management. Local flap recovery involves swelling and bruising for one to two weeks, with sutures removed at five to fourteen days and full recovery over four to eight weeks. Flaps may initially appear bulky and require later debulking for contour refinement.
Risks and Complications
Skin graft risks include graft failure, hypertrophic scarring, poor colour match, and donor site complications. Flap risks include necrosis (partial or complete), haematoma, infection, wound separation, bulkiness requiring revision, and donor site problems. Your surgeon will discuss risks specific to your reconstruction.
Frequently Asked Questions
How do you decide between a graft and a flap?
Multiple factors influence this — defect size and depth, wound bed vascularity, location, aesthetic importance, and patient health. Your surgeon will recommend the most appropriate option based on these considerations.
Will there be a scar at the donor site?
Will there be a scar at the donor site? Split-thickness graft donor sites heal with some colour change but no scar. Full-thickness donor sites leave a fine-line scar. Flap donor sites leave scars and sometimes contour changes.
THE SPECIALIST CLINIC DUBLIN
Plastic, Reconstructive & Aesthetic Surgery performed with Care & Compassion
If you have a wound or defect requiring reconstruction, contact us to arrange a consultation. We will assess the defect, explain the recommended approach, and provide detailed information about the procedure and expected outcomes.