Grafts and flaps

‘Grafts' and ‘flaps’ are the terms used to describe pieces of tissue that are transferred from one part of the body to another during reconstructive procedures. A graft is a piece of tissue that is detached from its site (and, most importantly, blood supply) of origin, and transferred to a different site, where it relies on the local blood supply to survive. Skin is the most commonly grafted tissue, but a graft may be of any tissue (e.g. fascia, fat, tendon, nerve, vessel, bone, composite tissue). The recipient bed must consist of healthy, well-vascularized tissue. Grafts cannot survive on poorly vascularized, densely scarred or irradiated tissue, tendon denuded of paratenon, bone denuded of periosteum, or infected tissue. The process of a graft acquiring a blood supply from its new recipient bed is termed ‘take’. A flap is a piece of tissue that has an integral blood supply. Flaps can be classified according to their site, geometry, composition or blood supply. Flaps can be used to cover poor recipient beds, joint contractures, to cover open fractures or joints, and to import blood supply in infected or irradiated wounds. Flaps can also be used to reconstruct specific structures, such as the thumb (toe transfer), breast (latissimus dorsi or free abdominal flap), mandible (fibular flap) and pharynx (jejunal flap). If there are several reconstructive options, the composition of the defect morbidity of the, donor site, patient preference and the surgeon's experience should be considered when choosing which flap to use.