Skin Graft, Types of Rejection, Flaps
& Classification (Bailey & Love)
• Based on Bailey & Love’s Short Practice of
Surgery
• Yashasvi Chauhan
• MBBS Second Year
Introduction
• Reconstructive surgery often involves skin
grafts and flaps.
• Bailey & Love’s Short Practice of Surgery
provides standard references.
What is a Skin Graft?
• • A skin graft is tissue transferred without its
own blood supply.
• • Survival depends on the vascularity of the
recipient site.
• • Commonly used for covering wounds, burns,
and defects.
Types of Skin Grafts
• • Split-Thickness Skin Graft (SSG): Includes
epidermis + part of dermis.
• • Full-Thickness Skin Graft (FTSG): Includes
epidermis + entire dermis.
• • Key differences: donor site healing,
contraction, and appearance.
Mechanism of Graft Take
• Stages of graft acceptance:
• 1. Adherence/Fibrin bonding
• 2. Plasmatic imbibition
• 3. Revascularization (inosculation +
neovascularization)
• 4. Remodeling and integration.
Types of Graft Rejection/Failure
• • Primary Graft Failure: Due to poor
vascularity, infection, or hematoma.
• • Delayed Graft Loss: Often from infection or
mechanical trauma.
• • Immunological rejection is rare in skin grafts
compared to organs.
Definition of Flaps
• • A flap is tissue transferred with its own
blood supply.
• • Unlike grafts, flaps maintain their vascularity.
• • Used when local vascularity is inadequate.
Flap Classification by Movement
• • Local Flaps: Adjacent to defect.
• - Advancement, Rotation, Transposition
• • Regional Flaps: Moved from nearby area,
still pedicled.
• • Distant/Free Flaps: Completely detached,
reattached microsurgically.
Flap Classification by Tissue Type
• • Cutaneous Flaps: Skin + superficial fascia.
• • Fasciocutaneous Flaps: Include deep fascia.
• • Musculocutaneous Flaps: Include muscle +
skin.
• • Osteocutaneous/Bone Flaps: Used for
structural reconstruction.
Flap Classification by Blood Supply
• • Random Pattern Flaps: Based on subdermal
plexus.
• • Axial Flaps: Supplied by named vessels.
• • Pedicled Flaps: Remain attached via pedicle.
• • Free Flaps: Completely detached,
revascularized microsurgically.
Summary & Key Takeaways
• • Skin grafts lack inherent blood supply.
• • Graft rejection usually due to technical
issues or infection.
• • Flaps are classified by movement, tissue
type, and vascularity.
References
• • Bailey & Love’s Short Practice of Surgery
• • TeachMeSurgery
• • NCBI StatPearls
• • Wikipedia - Flap Surgery
