WHAT YOU SHOULD KNOW
Traumatic wounds may be small or large, but what really matters is what lies underneath. If the wound exposes tendons, bones, joints, or nerves then it cannot be covered with a simple skin graft. It will require fully padded coverage with its own blood supply in the form of a flap. The word flap simply means a piece of tissue from the body that is used to reconstruct another area. Flaps may be local and stay connected by a piece of skin, regional and stay connected only by tiny blood vessels or free flaps that come completely separated and then rejoined by sewing together tiny blood vessels.
MEDICAL HISTORY
The details of the original injury circumstances are important to understand how much of the wound occurred due to cutting of tissue compared to crushing of tissue.
EXAMINATION
Measuring the dimensions of the wound and determining what other structures are injured in terms of fractures, dislocations, tendon and nerve lacerations.
ADDITIONAL TESTS
None are usually needed.
TREATMENT OPTIONS
| SKIN GRAFT | REGIONAL FLAP | FREE FLAP | |
| CONSISTS OF | Split or full thickness section of skin placed over wound | Full quality tissue coverage with its own attached blood supply | Full quality coverage with detachable blood supply |
| FEATURES | Taken from outside of thigh if large or from nearby on hand if small | Sources come from specific locations nearby according to a set of anatomic rules | Wide choice of sources come from all over the body |
| ADVANTAGES | Simplest method | No sewing of blood vessels required | Most versatile option, tailor to fit needs |
| DISADVANTAGES | No blood supply of its own, only works for wounds with no exposed structures | Flaps have size limitations and must reach to fit the wound | Sewing of blood vessels requires hospital stay and increases risk of complications |
RECOVERY
After skin grafting or regional flaps, patients may be discharged from the hospital. Rehabilitation may be delayed a week or so to allow the tissue to stabilize before stressing with motion. Thereafter the rehabilitation is geared mostly to the other injuries sustained to the joints and tendons (refer to the relevant medical conditions pages). After free flap surgery, the patient remains in the hospital for 5 days of continuous anticoagulant medication by vein.
