Type of Wound Closure Reconstructive ladder Types of skin graft On origin Comparison between full- and split-thickness graft Donor site selection Flaps Definition Flaps Types Classification OF SKIN flap Classification By vascular specificity TISSUE EXPANSION

2. Principles of
Reconstructive surgery
BY
Dr YASSER HELMY

3. Type of Wound Closure
Primary “1st intension”
Secondary ”2nd intension”
Tertiary ”3rd intension

4. Reconstructive ladder
•
A se t of rules favoring the most direct,
least-complex way of achieving the desired
result.
•
The least-complex types of treatments-such
as simple wound closure-are at the lower
part of the ladder
•
Any highly complex procedure-like micro-
surgery would occupy one of the ladder's
highest rungs.
•
A plastic surgeon will almost always begin
at the bottom

5. Reconstructive ladder
•
The size, nature and extent of
the injury or deformity will
determine what treatment
option is chosen and how
quickly the surgery will be
performed.

6. Reconstructive ladder
OPTIONS IN WOUND TREATMENT
SIMPLE WOUND CLOSURE
SKIN GRAFTS
TISSUE EXPANSION
ADVANCED WOUND CARE:
FLAP SURGERY/MICROSURGERY

7. GRAFT
Definition
A skin graft is a patch Of skin
that is surgically removed from
one area of the body and
transplanted to another

8. History of the
Procedure
• In India 2500-3000 years ago
• Riverdin’1st bios-kin transfer
• Thiersch's STSG in 1872.
• Wolfe's FTSG in 1875 and
1893.

9. Indications
• Extensive wounds
• Burns
• Specific surgeries that may require
skin grafts for healing to occur
• Areas of prior infection with
extensive skin loss
• Cosmetic reasons on reconstructive
surgeries
• inappropriate local skin flaps

14. Contraindications
• Cosmetic areas
• Durability areas
• Functional Areas
• Bad recipient bed
• A vascular bed(exposed bone or
cartilage)
• Uncontrolled bleeding

15. Types of skin graft
On origin
• Auto graft
• Homograft, same species; iso?
• Xenograft( hetero) – Skin taken
from an animal source
• Synthetic tissue

16. Types of skin graft
“Shape”
• Sheet
•Meshed skin grafting
•Stamps

19. Types of skin graft
“Thickness”
(a) Split-thickness graft divided
into
• Thin, (0.005-0.012 inches),
• Intermediate (0.012-0.018
inches),
• Thick (0.018-0.030 inches)

20. • (b)Full-thickness graft
• (c)Composite grafts -
combinations of skin and
fat; cartilage; or dermis and
fat, .

21. Comparison between full-
and split-thickness graft
• Take
• shrinkage
• Contracture
• Fragility&Stability
• Pigmentation
• Matching
• Re innervation
• Coverage
• Growth

22. Donor site selection
F TSG
• Hair growth
• Closed
• Facial symmetry
• Aesthetic units
• Sites)lid.postau.,-supraclav.,-
anticub.,-groin)

23. Donor site selection
STSG
• Easily concealed
• Common sites
• Anterior and lateral thigh
• Buttocks
• The scalp
• Upper inner arm

28. Flaps
Definition
•Flap is vascularized
tissue to be transferred
to reconstruct another
area

29. Flaps
Types
•
SKIN
•
MYOCUYANOUS
•
FASCIOCUTANOUS

31. Classification OF
SKIN flap
•By vascular anatomy
•By vascular specificity
•By mobilization

32. Classification By
vascular anatomy
• Segmental vasculature
• Perforating vessels
• Cutaneous vasculature
(a)Musclo cutaneous
perforator
(b)Direct cutaneous
perforator

33. Classification By
vascular specificity
•Random pattern flap
•Axial pattern flap
“Island flap”

34. Skin flap

35. By mobilization
By mobilization
Local distant
ROTATIONAL
ADVANCEMENT
TRANSPOSITIONAL
INTERLOBATED
SIMPLE PEDICLE
BIPEDICLE
V-Y

36. TISSUE EXPANSION

37. AESTHETIC SURGERY
DEFINATIONS
RHINOPLASTY
FACE LIFTING
EYELIDS SURGERY
BREAST SURGERIES
LIPOSUCTION

38. Dr Yasser Helmy
•
Thank you