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Skin Grafts and Local Flaps

Hallock, Geoffrey G. M.D.; Morris, Steven F. M.D., M.Sc.

Plastic and Reconstructive Surgery: January 2011 - Volume 127 - Issue 1 - p 5e-22e
doi: 10.1097/PRS.0b013e3181fad46c
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Learning Objectives: After reading this article, the participant should be able to: 1. Understand the difference between skin grafts and local flaps. 2. Know the available “workhorse” flaps for all body regions. 3. Have access to surgical techniques for basic flap harvest.

Summary: Expedited healing of skin wounds is essential regardless of surgical specialty. Any skin deficiency will thwart this basic intent, and an alternative must be sought. The autogenous skin graft or local flap has long had a major role in satisfying this objective. Various forms of autogenous skin grafts are to be differentiated from local flaps, primarily on the basis of vascularization. The indications for either, their surgical anatomy, harvest techniques, and limitations, including pitfalls, need to be outlined. Skin grafts are the simplest means to restore skin integrity. If skin grafts are contraindicated, a flap may be essential. For this purpose, the “top ten” local “workhorse” flaps are briefly described in this article. Accompanying videos further elaborate the requisite surgical anatomy and harvest techniques. As a problem-solving specialty, it is incumbent upon us to first prevent, then be able to provide rapid, efficient, and efficacious healing of, any surgical wound, iatrogenic or otherwise. Skin grafts and local flaps are fundamental elements for achieving this goal when healing by primary or secondary intent is not possible. Whether one is a “reconstructive” or “aesthetic” plastic surgeon, knowledge of these basic tenets will ensure maintenance of competency.


Bethlehem and Allentown, Pa.; and Halifax, Nova Scotia, Canada

From the Division of Plastic Surgery, St. Luke's Hospital; Sacred Heart Hospital; Lehigh Valley Hospital; and the Departments of Surgery and Anatomy, Dalhousie University.

Received for publication July 22, 2009; accepted January 12, 2010.

Presented in part at the First Mayo Clinic/Chung Gung University Medical College Symposium in Reconstructive Microsurgery, in Rochester, Minnesota, June 5, 2009.

Disclosure:The authors have no financial interest to declare in relation to the content of this article.

Related Video content is available for this article. The videos can be found under the “Related Videos” section of the full-text article, or, for Ovid users, using the URL citations printed in the article.

Geoffrey G. Hallock, M.D.; 1230 South Cedar Crest Boulevard, Suite 306; Allentown, Pa. 18103;

©2011American Society of Plastic Surgeons