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1. Preparation

WHAT ARE SKIN GRAFTS AND FLAPS?

Skin Graft :


A skin graft is a procedure performed where healthy skin is removed from one area of the body, the donor site, and transplanted to another, the recipient site. The areas of the body that are most commonly used as donor sites for skin grafts are the leg, inner thigh, upper arm, forearm and buttocks.

There are two main types of skin grafts and they are:

Split or partial thickness graft – This is the most common type of graft. The epidermis (the top layer of the skin) and part of the dermis (the middle layer of the skin) are removed from the donor site and transplanted on the damaged area. It is possible that the graft can be spread over a mesh to increase the surface area covered. This type of graft heals relatively quickly but is quite fragile and not suitable for deep or infected wounds and the cosmetic result is often not good. Skin on the donor site can grow back from sweat glands and hair follicles.

Full thickness graft – The entire epidermis and dermis are transplanted to the recipient site. Although the cosmetic effects can be good, full thickness grafts are only suitable for small areas. The donor site needs to either be closed with stiches, or have a partial thickness graft transplanted.


Skin Flap:

A skin flap is similar to a graft in that a transplantation of tissue occurs. The essential difference between the two is that a flap exists on it’s own blood supply. This means that much larger amounts of tissue can be transported, including muscle if required. There are many different types of surgical techniques used to create flaps, but they can be broadly classified into the following groups:


  • Local flap– This is when the donor site is immediately adjacent to the recipient site. The required area of skin and tissue is moved without interrupting the blood supply.

  • Distant flap– Distant flap is when a flap is from an entirely different area of the body, for example, a flap taken from the leg might be used for a wound on the neck. This may be achieved over the course of two or more operations depending on the complexity of the reconstruction.

  • Free Flap– A Free flap is also a distant flap but the procedure is done in one stage using microsurgery to repair the blood and donor vessels establishing immediate blood flow.

skin-grafts.gif

WHY IS IT DONE?

Skin grafts and flaps are required to treat a number of different conditions but the following are the most common:

  • Extensive trauma or chronic wound
  • Severe burns
  • Areas of prior infection
  • Reconstructive surgery following major surgery for cancer

HOW DO I CHOOSE A SPECIALIST?

Your GP, or the doctor you first consulted, will be able to recommend and refer you to a Plastic & Reconstructive surgeon who can perform the procedure. Some very simple procedures may be performed by a dermatologist.

You may be happy to accept the advice of your GP with regard to a specialist, or you may like to investigate your choices; either option is safe and valid. In Australia each medical speciality has a governing body to which the consultants belong. These are often good organisations to turn to for information about what you can expect from your medical specialist. You can access the Royal Australian College of Surgeons via their website: http://www.surgeons.org/

The list of questions below may help you to better understand your treatment, and if necessary decide on a particular doctor. Practical issues you may also like to consider are what hospital(s) a particular doctor operates from, and what their fees are. (If you need more information about fee setting and gap arrangements, please refer to our brochure “what you should know before going into hospital”, which is also available on the HCF website).


To access a list of Plastic & Reconstructive surgeons who participate in HCF’s Medicover no gap arrangement:


WHAT SHOULD I ASK MY SPECIALIST?

  • What type of graft or flap is best for me, and why?
  • Is your surgeon experienced in all forms of reconstructive surgery, including microsurgery?
  • What are the likely cosmetic results – make sure you have realistic expectations
  • Make sure you fully understand the procedure which is planned; do not be afraid to ask. It is your right to know all the relevant information, as this is part of informed clinical consent. Your doctor will ask you to sign a consent form.
  • In addition to what the procedure involves, you should also ask about:
      • Preparation
      • Follow up appointments
      • Aftercare
  • Most medication should be continued as usual, but some may interfere with the examination. Your doctor will inform you of the medication you should stop. As a guide the following medication may require special instruction:
      • Aspirin (or any related products),
      • Blood thinners (Warfarin, heparin),
      • Arthritis medication,
      • Pain medication, Insulin.

WHERE IS IT DONE?

Simple skin grafts and flaps can be done in a day surgery, whilst more complex procedures will be done in an overnight hospital.

HOW LONG IS THE PROCEDURE?

The length of time required for a skin graft or flap varies enormously depending on the type, size and situation. A simple split skin graft may take less than an hour, whilst a complicated free flap could last as long as 10 or 12 hours.

WHO IS INVOLVED?

The procedure is usually carried out as a patient in a specialised day surgery or hospital. The people involved in the procedure are:

  • The Plastic & Reconstructive surgeon, your specialist doctor
  • An assistant surgeon will be required for some operations – check with your specialist
  • Anaesthetist: they administer the general anaesthetic, look after you whilst the procedure is being carried out, and are responsible for your post operative pain relief
  • Specialised Nurses for the procedure and recovery
  • Pathologist if any blood tests are necessary
  • Radiologist if x-rays are required

HOW DO I PREPARE FOR A SKIN GRAFT OR FLAP?

Because the operation will be done under a general anaesthetic, you may need to undergo some basic tests to ensure your overall health is suitable for the procedure. This will depend on your age and health, and could include things such as an ECG (recording of your heart rhythm), chest x-ray and blood tests. You should endeavour to be as healthy as possible prior to surgery; if you are a smoker, and you can’t give up permanently, you should try to avoid smoking immediately prior to the operation.

You will be given instructions on when to start fasting – normally at least 6 to 8 hours prior to the procedure. Your doctor will have his/her own specific preparation requirements. These instructions should be strictly followed or the procedure may be unsatisfactory and may have to be repeated at a later date.

WHAT DO I TAKE WITH ME TO THE DAY SURGERY/HOSPITAL?

  • Any recent, relevant x-rays or scans
  • Do not bring any valuables with you, some change for newspapers etc. is all you should require
  • Leave all jewellery at home (sometimes a plain band is acceptable)
  • Wear comfortable clothing
  • Bring any medication that you would usually take during the day, under most circumstances you may still be able to take these
  • Remove all nail polish and do not wear any make-up

2. Costs and Charges

WHAT IS IT GOING TO COST?

Ask your doctor whether he will participate in HCF’s no gap arrangement for your surgery so that you do not incur any out of pocket expense. If your doctor does not wish to participate, it is your doctor’s responsibility to fully inform you of your financial liability and any out of pocket expense prior to you consenting to the surgery.

For your information, the average charges for claims paid for Skin Grafts and Flaps admissions for the financial year 12/13 are provided below:

On Average

Charge Medicare Pays HCF Pays 3 If your doctor DOES NOT use HCF’s No Gap Arrangement YOU PAY % of all admissions where your doctor DOES NOT use HCF’s No Gap Arrangement 4 If your doctor USES HCF’s No Gap Arrangement YOU PAY % of all admissions where your doctor USES HCF’s No Gap Arrangement
Total Average Hospital Component (accommodation, theatre and hospital related services) $1,344 $0 $1,343
1 Medical Services Component
Anaesthetic Services $485 $177 $193 $361 31.6% $0 68.4%
General Surgical Services $274 $123 $88 $209 29.1% $0 70.9%
Pathology Services $190 $100 $86 $66 4.5% $0 95.5%
Plastic & Reconstructive Surgical Services $830 $340 $297 $668 28.9% $0 71.1%
2 Total Average Medical Services $1,514 $631 $563 $820 38.6% $0 61.4%
Hospital and Medical Services Average for Skin Grafts and Flaps Admissions $2,858 $631 $1,906 $820 38.6% $0 5 61.4%

skin_grafts_13.gif

Points to Note:

  • Charges are based on HCF claims for a sample size of 2,389 same day admissions in participating day surgeries or private participating hospitals (day surgeries/private hospitals that have an agreement with HCF for accommodation, theatre and hospital related services) – covered under Medicare item 45451,45203 and 45206.

  • As a private patient in a non-participating hospital you may incur an out of pocket expense for the hospital component (accommodation, theatre and hospital related services).

  • There is no excess payable for same day admissions.

1 These medical services are in-patient services only.

2 The medical charges are based on averages and each episode of care is different, i.e. you may not have all of these medical services, and/or you may also have other medical services not indicated here e.g. diagnostic procedures. Therefore, the total average medical service charge ($1,514) differs from the sum of the individual average charges as shown.

3 Doctors who do not use the HCF no-gap arrangement have a higher average out of pocket charge, as their charges are higher than those doctors who use the no-gap arrangement and incur nil out of pocket charges to the patient. Therefore, the sum of the average benefits plus the average out of pocket charge you pay will not equate to the charge as shown in the table.

4 Doctors’ charges vary so always ask your doctor whether he/she will participate in HCF’s No Gap Arrangements.

HCF Medicover Schedule of Benefits lists all services for extra benefit in excess of the Commonwealth Medicare Benefits Schedule (CMBS) fee, which providers, registered under the HCF Medicover No Gap arrangement will receive as full payment for services provided. This also applies to unregistered providers should they charge within the schedule of benefit listed. This arrangement ensures that our members incur no out of pocket expense.

5 This percentage indicates the total coverage of hospital and medical services for all skin grafts and flaps. The percentages shown for each type of medical service are much higher as they are calculated for those services only and not the entire admission, which includes all medical services and the hospital services. In an admission you may have one medical service with an out of pocket expense, which then excludes the whole admission from being fully covered. Hence the significant difference in percentage for individual types of medical services as compared to the total admission fully covered

3. Day of procedure

WHAT HAPPENS TO ME AT THE DAY SURGERY/HOSPITAL?

When you arrive at the day surgery or hospital, the admissions clerk will attend to the paperwork associated with your stay.

On arrival to the ward area a nurse will perform some basic tests and observations, and check your medical history and current medications. Please remember to mention any herbal or homeopathic remedies you are taking, as these can have interactions and side effects too.


Your surgeon will probably have already talked you through the risks and benefits of the procedure and asked you to sign a consent form, but if not this should be done before you get to the theatre area. Your anaesthetist may see you either in the ward or once you arrive in the anaesthetic bay, depending on the complexity of your situation.

Prior to being taken to theatre, you may be given a pre-medication to ensure you are relaxed and slightly drowsy before arriving.

WHAT CAN I EXPECT DURING A SKIN GRAFT OR FLAP?

Once in the anaesthetic bay of the operating theatre, a small plastic tube called a cannula will be placed into a vein in your arm or hand. If it is general anaesthetic being given, the cannula is used to administer intravenous sedation, which is the first stage of your anaesthetic. If you are having local anaesthetic, an injection will be given. This may sting briefly. Once the anaesthetic has taken effect, you will be moved into the operating theatre.

There are numerous (too numerous to describe) different techniques employed to achieve each of the different types of skin flaps and grafts. However, usually the following principles will apply:

Obviously both recipient and donor sites are carefully selected, prepared and marked. Sometimes the recipient site is made smaller with a special stitch called a purse string suture, to reduce the graft size.

Split Skin Grafts (SSG)are generally harvested with an instrument called a dermatome which enables a precisely measured layer of skin to be removed. The graft is placed in sterile saline (salt) solution. Before application to the recipient site, it can be trimmed or meshed (placed over a graft meshing machine to increase surface size) as required. It is sutured in place and covered with a dressing of the surgeon’s choice. The donor site is covered with a dressing and heals without surgical intervention.

Full Thickness Skin Grafts (FTSG) are harvested using a scalpel because the entire epidermis and dermis is removed. The graft is usually taken using a template and should exactly fit the recipient site, where it is sutured in place. The donor site needs to be closed either with sutures, or with the aid of a SSG from elsewhere.

Local Flaps are taken from the area adjacent to the recipient site and transferred whilst keeping the blood supply intact. The donor site may be closed with a suture or grafted with a SSG depending on the nature of the wound.

Distant Flaps require blood supply to remain in tact from the donor site, even though the recipient might be on another part of the body. The intact blood vessels are tunnelled under the skin to their new location. Sometimes this type of reconstruction may require more than one operation.

Free Flaps require, in addition to removal and repositioning of skin, fat and/or muscle, removal and reconnection of at least one blood vessel. This is achieved by extremely meticulous microsurgery. A common example of this type of flap would be a TRAM flap, using the abdominal muscle and fat to reconstruct breast tissue after mastectomy.

4. Aftercare

WHAT HAPPENS AFTER A SKIN GRAFT OR FLAP?

After the surgery you will be taken to the recovery room. Nursing staff will check on you regularly, taking your blood pressure, checking your pulse and monitoring your breathing. You may be wearing an oxygen mask when you first wake up, and you may also be hooked up to an intravenous drip to replace the fluids lost during surgery. It will be removed once you are drinking fluids and have passed urine.

Occasionally, if you have had a large flap, especially a free flap, you might be looked after in the Intensive Care Unit (ICU) following the operation. The increased nurse to patient ratio means that your flap can be very closely monitored to detect any changes in blood circulation. You may also have additional drips and monitoring devices attached to you. If you are booked to have a stay in intensive care, you might like to ask a nurse on the ward if you can visit the unit the night before your operation. This can help familiarise yourself and your family with what to expect.

The length of time you will spend in hospital varies tremendously depending on the site, size and type of the repair. If you are having a simple graft in a day surgery you will obviously be discharged home the same day. A complicated flap may require observation in hospital for over a week.

Upon discharge you will be given detailed instructions for care at home. It is important that you follow instructions carefully to promote correct healing. You will usually have to return to see your surgeon to have the sutures removed and so that he or she can check the progress of your wound(s).

Before leaving hospital, ensure you have been given adequate advice about the following issues:

  • Any wound care necessary
  • Changes for which you should seek further medical attention, such as increased pain or discharge
  • Follow up appointments
  • Any restrictions placed on your normal level of activity
  • Any changes to your usual medication

1.Preparation

WHAT ARE SKIN GRAFTS AND FLAPS?

Skin Graft :


A skin graft is a procedure performed where healthy skin is removed from one area of the body, the donor site, and transplanted to another, the recipient site. The areas of the body that are most commonly used as donor sites for skin grafts are the leg, inner thigh, upper arm, forearm and buttocks.

There are two main types of skin grafts and they are:

Split or partial thickness graft – This is the most common type of graft. The epidermis (the top layer of the skin) and part of the dermis (the middle layer of the skin) are removed from the donor site and transplanted on the damaged area. It is possible that the graft can be spread over a mesh to increase the surface area covered. This type of graft heals relatively quickly but is quite fragile and not suitable for deep or infected wounds and the cosmetic result is often not good. Skin on the donor site can grow back from sweat glands and hair follicles.

Full thickness graft – The entire epidermis and dermis are transplanted to the recipient site. Although the cosmetic effects can be good, full thickness grafts are only suitable for small areas. The donor site needs to either be closed with stiches, or have a partial thickness graft transplanted.

Skin Flap:


A skin flap is similar to a graft in that a transplantation of tissue occurs. The essential difference between the two is that a flap exists on it’s own blood supply. This means that much larger amounts of tissue can be transported, including muscle if required. There are many different types of surgical techniques used to create flaps, but they can be broadly classified into the following groups:


  • Local flap – This is when the donor site is immediately adjacent to the recipient site. The required area of skin and tissue is moved without interrupting the blood supply.

  • Distant flap – Distant flap is when a flap is from an entirely different area of the body, for example, a flap taken from the leg might be used for a wound on the neck. This may be achieved over the course of two or more operations depending on the complexity of the reconstruction.

  • Free Flap – A Free flap is also a distant flap but the procedure is done in one stage using microsurgery to repair the blood and donor vessels establishing immediate blood flow.

skin-grafts.gif

WHY IS IT DONE?

Skin grafts and flaps are required to treat a number of different conditions but the following are the most common:

  • Extensive trauma or chronic wound
  • Severe burns
  • Areas of prior infection
  • Reconstructive surgery following major surgery for cancer

HOW DO I CHOOSE A SPECIALIST?

Your GP, or the doctor you first consulted, will be able to recommend and refer you to a Plastic & Reconstructive surgeon who can perform the procedure. Some very simple procedures may be performed by a dermatologist.

You may be happy to accept the advice of your GP with regard to a specialist, or you may like to investigate your choices; either option is safe and valid. In Australia each medical speciality has a governing body to which the consultants belong. These are often good organisations to turn to for information about what you can expect from your medical specialist. You can access the Royal Australian College of Surgeons via their website: http://www.surgeons.org/

The list of questions below may help you to better understand your treatment, and if necessary decide on a particular doctor. Practical issues you may also like to consider are what hospital(s) a particular doctor operates from, and what their fees are. (If you need more information about fee setting and gap arrangements, please refer to our brochure “what you should know before going into hospital”, which is also available on the HCF website).


To access a list of Plastic & Reconstructive surgeons who participate in HCF’s Medicover no gap arrangement:


WHAT SHOULD I ASK MY SPECIALIST?

  • What type of graft or flap is best for me, and why?

  • Is your surgeon experienced in all forms of reconstructive surgery, including microsurgery?

  • What are the likely cosmetic results – make sure you have realistic expectations

  • Make sure you fully understand the procedure which is planned; do not be afraid to ask. It is your right to know all the relevant information, as this is part of informed clinical consent. Your doctor will ask you to sign a consent form.

  • In addition to what the procedure involves, you should also ask about:
      • Preparation
      • Follow up appointments
      • Aftercare
  • Most medication should be continued as usual, but some may interfere with the examination. Your doctor will inform you of the medication you should stop. As a guide the following medication may require special instruction:
      • Aspirin (or any related products),
      • Blood thinners (Warfarin, heparin),
      • Arthritis medication,
      • Pain medication, Insulin.

WHERE IS IT DONE?

Simple skin grafts and flaps can be done in a day surgery, whilst more complex procedures will be done in an overnight hospital.

HOW LONG IS THE PROCEDURE?

The length of time required for a skin graft or flap varies enormously depending on the type, size and situation. A simple split skin graft may take less than an hour, whilst a complicated free flap could last as long as 10 or 12 hours.

WHO IS INVOLVED?

The procedure is usually carried out as a patient in a specialised day surgery or hospital. The people involved in the procedure are:

  • The Plastic & Reconstructive surgeon, your specialist doctor
  • An assistant surgeon will be required for some operations – check with your specialist
  • Anaesthetist: they administer the general anaesthetic, look after you whilst the procedure is being carried out, and are responsible for your post operative pain relief
  • Specialised Nurses for the procedure and recovery
  • Pathologist if any blood tests are necessary
  • Radiologist if x-rays are required

HOW DO I PREPARE FOR A SKIN GRAFT OR FLAP?

Because the operation will be done under a general anaesthetic, you may need to undergo some basic tests to ensure your overall health is suitable for the procedure. This will depend on your age and health, and could include things such as an ECG (recording of your heart rhythm), chest x-ray and blood tests. You should endeavour to be as healthy as possible prior to surgery; if you are a smoker, and you can’t give up permanently, you should try to avoid smoking immediately prior to the operation.

You will be given instructions on when to start fasting – normally at least 6 to 8 hours prior to the procedure. Your doctor will have his/her own specific preparation requirements. These instructions should be strictly followed or the procedure may be unsatisfactory and may have to be repeated at a later date.

WHAT DO I TAKE WITH ME TO THE DAY SURGERY/HOSPITAL?

  • Any recent, relevant x-rays or scans
  • Do not bring any valuables with you, some change for newspapers etc. is all you should require
  • Leave all jewellery at home (sometimes a plain band is acceptable)
  • Wear comfortable clothing
  • Bring any medication that you would usually take during the day, under most circumstances you may still be able to take these
  • Remove all nail polish and do not wear any make-up

2. Costs and Charges

WHAT IS IT GOING TO COST?

Ask your doctor whether he will participate in HCF’s no gap arrangement for your surgery so that you do not incur any out of pocket expense. If your doctor does not wish to participate, it is your doctor’s responsibility to fully inform you of your financial liability and any out of pocket expense prior to you consenting to the surgery.

For your information, the average charges for claims paid for Skin Grafts and Flaps admissions for the financial year 12/13 are provided below:

On Average

Charge Medicare Pays HCF Pays 3 If your doctor DOES NOT use HCF’s No Gap Arrangement YOU PAY % of all admissions where your doctor DOES NOT use HCF’s No Gap Arrangement 4 If your doctor USES HCF’s No Gap Arrangement YOU PAY % of all admissions where your doctor USES HCF’s No Gap Arrangement
Total Average Hospital Component (accommodation, theatre and hospital related services) $1,344 $0 $1,343
1 Medical Services Component
Anaesthetic Services $485 $177 $193 $361 31.6% $0 68.4%
General Surgical Services $274 $123 $88 $209 29.1% $0 70.9%
Pathology Services $190 $100 $86 $66 4.5% $0 95.5%
Plastic & Reconstructive Surgical Services $830 $340 $297 $668 28.9% $0 71.1%
2 Total Average Medical Services $1,514 $631 $563 $820 38.6% $0 61.4%
Hospital and Medical Services Average for Skin Grafts and Flaps Admissions $2,858 $631 $1,906 $820 38.6% $0 5 61.4%

skin_grafts_13.gif

Points to Note:

  • Charges are based on HCF claims for a sample size of 2,389 same day admissions in participating day surgeries or private participating hospitals (day surgeries/private hospitals that have an agreement with HCF for accommodation, theatre and hospital related services) – covered under Medicare item 45451,45203 and 45206.

  • As a private patient in a non-participating hospital you may incur an out of pocket expense for the hospital component (accommodation, theatre and hospital related services).

  • There is no excess payable for same day admissions.

1 These medical services are in-patient services only.

2 The medical charges are based on averages and each episode of care is different, i.e. you may not have all of these medical services, and/or you may also have other medical services not indicated here e.g. diagnostic procedures. Therefore, the total average medical service charge ($1,514) differs from the sum of the individual average charges as shown.

3 Doctors who do not use the HCF no-gap arrangement have a higher average out of pocket charge, as their charges are higher than those doctors who use the no-gap arrangement and incur nil out of pocket charges to the patient. Therefore, the sum of the average benefits plus the average out of pocket charge you pay will not equate to the charge as shown in the table.

4 Doctors’ charges vary so always ask your doctor whether he/she will participate in HCF’s No Gap Arrangements.

HCF Medicover Schedule of Benefits lists all services for extra benefit in excess of the Commonwealth Medicare Benefits Schedule (CMBS) fee, which providers, registered under the HCF Medicover No Gap arrangement will receive as full payment for services provided. This also applies to unregistered providers should they charge within the schedule of benefit listed. This arrangement ensures that our members incur no out of pocket expense.

5 This percentage indicates the total coverage of hospital and medical services for all skin grafts and flaps. The percentages shown for each type of medical service are much higher as they are calculated for those services only and not the entire admission, which includes all medical services and the hospital services. In an admission you may have one medical service with an out of pocket expense, which then excludes the whole admission from being fully covered. Hence the significant difference in percentage for individual types of medical services as compared to the total admission fully covered

3. Day of procedure

WHAT HAPPENS TO ME AT THE DAY SURGERY/HOSPITAL?

When you arrive at the day surgery or hospital, the admissions clerk will attend to the paperwork associated with your stay.

On arrival to the ward area a nurse will perform some basic tests and observations, and check your medical history and current medication. Please remember to mention any herbal or homeopathic remedies you are taking, as these can have interactions and side effects too.


Your surgeon will probably have already talked you through the risks and benefits of the procedure and asked you to sign a consent form, but if not this should be done before you get to the theatre area. Your anaesthetist may see you either in the ward or once you arrive in the anaesthetic bay, depending on the complexity of your situation.

Prior to being taken to theatre, you may be given a pre-medication to ensure you are relaxed and slightly drowsy before arriving.

WHAT CAN I EXPECT DURING A SKIN GRAFT OR FLAP?

Once in the anaesthetic bay of the operating theatre, a small plastic tube called a cannula will be placed into a vein in your arm or hand. If it is general anaesthetic being given, the cannula is used to administer intravenous sedation, which is the first stage of your anaesthetic. If you are having local anaesthetic, an injection will be given. This may sting briefly. Once the anaesthetic has taken effect, you will be moved into the operating theatre.

There are numerous (too numerous to describe) different techniques employed to achieve each of the different types of skin flaps and grafts. However, usually the following principles will apply:

Obviously both recipient and donor sites are carefully selected, prepared and marked. Sometimes the recipient site is made smaller with a special stitch called a purse string suture, to reduce the graft size.

Split Skin Grafts (SSG)are generally harvested with an instrument called a dermatome which enables a precisely measured layer of skin to be removed. The graft is placed in sterile saline (salt) solution. Before application to the recipient site, it can be trimmed or meshed (placed over a graft meshing machine to increase surface size) as required. It is sutured in place and covered with a dressing of the surgeon’s choice. The donor site is covered with a dressing and heals without surgical intervention.

Full Thickness Skin Grafts (FTSG) are harvested using a scalpel because the entire epidermis and dermis is removed. The graft is usually taken using a template and should exactly fit the recipient site, where it is sutured in place. The donor site needs to be closed either with sutures, or with the aid of a SSG from elsewhere.

Local Flaps are taken from the area adjacent to the recipient site and transferred whilst keeping the blood supply intact. The donor site may be closed with a suture or grafted with a SSG depending on the nature of the wound.

Distant Flaps require blood supply to remain in tact from the donor site, even though the recipient might be on another part of the body. The intact blood vessels are tunnelled under the skin to their new location. Sometimes this type of reconstruction may require more than one operation.

Free Flaps require, in addition to removal and repositioning of skin, fat and/or muscle, removal and reconnection of at least one blood vessel. This is achieved by extremely meticulous microsurgery. A common example of this type of flap would be a TRAM flap, using the abdominal muscle and fat to reconstruct breast tissue after mastectomy.

4. Aftercare

WHAT HAPPENS AFTER A SKIN GRAFT OR FLAP?

After the surgery you will be taken to the recovery room. Nursing staff will check on you regularly, taking your blood pressure, checking your pulse and monitoring your breathing. You may be wearing an oxygen mask when you first wake up, and you may also be hooked up to an intravenous drip to replace the fluids lost during surgery. It will be removed once you are drinking fluids and have passed urine.

Occasionally, if you have had a large flap, especially a free flap, you might be looked after in the Intensive Care Unit (ICU) following the operation. The increased nurse to patient ratio means that your flap can be very closely monitored to detect any changes in blood circulation. You may also have additional drips and monitoring devices attached to you. If you are booked to have a stay in intensive care, you might like to ask a nurse on the ward if you can visit the unit the night before your operation. This can help familiarise yourself and your family with what to expect.

The length of time you will spend in hospital varies tremendously depending on the site, size and type of the repair. If you are having a simple graft in a day surgery you will obviously be discharged home the same day. A complicated flap may require observation in hospital for over a week.

Upon discharge you will be given detailed instructions for care at home. It is important that you follow instructions carefully to promote correct healing. You will usually have to return to see your surgeon to have the sutures removed and so that he or she can check the progress of your wound(s).

Before leaving hospital, ensure you have been given adequate advice about the following issues:

  • Any wound care necessary
  • Changes for which you should seek further medical attention, such as increased pain or discharge
  • Follow up appointments
  • Any restrictions placed on your normal level of activity
  • Any changes to your usual medication
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Disclaimer: Information is provided by HCF in good faith for the convenience of members. It is not an endorsement or recommendation of any form of treatment, nor is it a substitute for medical advice, and you should rely on the advice of your treating doctors in relation to all matters concerning your health. Every effort has been taken to ensure the accuracy of this information, however, HCF takes no responsibility for any injury, loss, damage or other consequence of the use of this information.