Terminology - grafts & flaps - what they are

[mole]

I hope this will come in handy for those trying to decipher surgical speak.

Skin grafts
Skin is removed from one part of the body and applied/secured onto another part. Skin is made up of two distinct layers - the epidermis (top layer containing the main skin cells that grow) and the dermis (bottom layer containing hair follicles etc).
1. Split thickness skin grafts (SSG/STSG) are "shaved" off the skin, taking off the epidermis and usually a very thin layer of the dermis. The donor area (where the graft was taken from) is normally left to heal like a big graze and this usually takes 2-3 weeks. The area will look pink at first and then settle within months to a couple of years. The grafted skin may have holes in it to allow any fluid to escape and make it stretch to cover a larger area. This gives it a "string vest" appearance after it heals. The grafted skin will not have normal skin colour because the pigment cells do not tend to survive. It also tends to get dry easily and be crusty or flaky because it does not have the normal glands in the skin that keep it moist. This is why it is important to moisturise and massage the grafted area (and the donor area). These areas need to be kept away from the sun for a couple of years (cover up with clothing and/or sunscreen) as they are more susceptible to reacting to the sun.
2. Full thickness skin grafts (FTSG) remove both layers - the epidermis and dermis, with fat removed. The graft retains hair and tends to be less dry. The colour of the grafted skin could become lighter (hypopigmentation) or darker (hyperpigmentation) with time, compared to the surrounding normal skin. The donor area is sutured into a neat scar that forms a line.
3. Mucosal grafts are normally taken from the inside lining of the cheek. This is to replace areas of mucosa like the pink bit of the eyelid and the inside lining of the urethra. The advantage is hairless skin that is similar in texture and function as the areas it replaces. If the donor area is small, it can be left to heal by itself. If it is larger, it can be stitched up. Sometimes, the uppermost layer of mucosal grafts could be slowly replaced with cells that are normally found on skin and eventually take on the appearance of skin in a process called keratinasation.
4. Composite grafts contain other structures apart from skin, e.g. fat, cartilage.


Flaps
Flaps can contain two or more structures, e.g. skin, fat, fascia, muscle, bone, nerve. If it carries its own blood supply, it is a pedicled flap. If it is lifted from one part of the body and reattached to another part, with its blood vessels reattached (anastomosis), it is a free flap. This is a simplification of flap categorisation.