hello and welcome to a new video so in this video I will talk about the skinny graft and the flap and I will explain them in details so this picture here is of a graft and the second picture is a flap so the graft picture is that this patient burned the lower part of their leg and it is treated by placing a graft over the burned area while the second picture is that this patient had a marginal ulcer over their head and it's treated by excising the ulcer and replacing a flap so with that let's start so we will start with an overview and then we will explain the graft and then the flap so a skin grafting or flapping is a type of surgery involves transplantation of skin from the donor side to the recipient site and it has many uses but the main ones is that it is used in the transplantation of skin and extensive wounds or trauma and burns in areas of extensive skin loss due to infection and it is used in transplantation of skin and cell and surgery is requiring skin replacement like removal of skin cancers and now let's explain the skinny graft so the skin graft consists of epidermis and some portion of the dermis that is removed from its blood supply and transferred to another location so it's basically epidermis plus some portion of the dermis and the blood supply is removed so now blood supply to the graft and we have an example here so this patient had an ulceration over their middle finger and it is treated by excising the ulcer like that and the grafting which end up as that and now for the skin graft cruises so it is used to close any wound with good blood supply because remember the graph doesn't have a blood supply and the wound has to have a good supply for The graft to live so grafts also used for temporary closure of wounds and burns so basically if the patient had some burn over their limb it would be temporarily closed and to allow the skin to grow without getting infected so basically in case of allografts giving duration that keep them covered for two weeks and then they automatically shed because of rejection allografts mean that the graft is taken from another person and giving to the patient just to temporarily let the skin grow and this would automatically shed because remember the allograft would be rejected by the dot by the recipient body and it would shed now also skin graft used to control infection and use to close donor sites in case they can flap from the donor and the site was large it is closed with the craft so basically when we take a flap from a person and the flap side was big we use the graph to close it and it's also used in mucosal replacement for the urethra and the oral cavity now for the types of skin graft so we have the autographed we have the yellow graft which is also called the homograph and we have the Xeno graft which is also called the history craft so for the autographed means that it is taken from the same person for the allograft it is from different human and xenograft is from different species now graph types according to thickness we have full thickness skin grafts and we have partial thickness skinny grafts the full thickness is that it contains epidermis and the entire dermis with its elastic fibers and full thickness skinny grafts have elastic properties and the primary contracture which make it good for replacing sites that need elasticity like the anterior elbow joint skin and now the full thickness graft allows for more for more elastic fibers to be available in the dermis and this would make the graft become more mobile which make it perfect for replacing the skin over the joints now for the partial skinny grafts they contain epidermis and varying degrees of the dermis and it is associated with secondary contracture now we will explain the primary contracture and secondary contracture so the primary contracture is the immediate recoil of freshly harvested grafts as a result of the elastin in the dermis the more the thickness of the dermis the more primary contracture and the primary contracture is good type of contracture making raft more elastic and perfect for replacing the skin over the joints the secondary contracture on the other hand involves the contracture of the healed graft due to myofibroblasts activity and it is more insulated thickness grafts as we mentioned the secondary contracture is bad because it makes the graft more prone to hypertrophic scarring now let's talk about the survival of the skinny graft so it depends on the ability of the graph to receive nutrients through revascularization revascularization of the skin graft occurs in three phases phase one is the serum and vibration phase which lasts for the first 24 hours after a grafting a procedure when the graft is placed into the recipient bed binding The graft to the bed absorption of the nutrias into the graft occurs by capillary action from the recipient bed so in the first 24 hours after grafting you graft leaves because it it absorbs the nutrients in the in the recipient Tibet the second phase is the inosculation phase for the second 24 hours after grafting in which the vascular network is established between the cut vessels on the underside of the skin graft and the capillary beds and we won't bed the third phase is the revascularization phase and in the third it occurs in the third 24 hours after grafting and The graft is revascularized through kissing of the capillaries that are already formed in phase two so basically when they form in phase two they would kiss each other in the phase three so they would reach the Final revascularization Phase now sometimes the graft fail and it is due to Clauses so the first one is that hematoma under the craft this would lead to elevation of The graft and no kissing of the blood vessels occurs also graft fails due to infection and due to inadequate immobilization like in anterior elbow you want to root backslab to immobilize the elbow for success of big light so you basically stabilize the elbow in order to for the for the craft on the interior elbow to survive also miss evaluation of the wound that is in bed with poor blood supply or infection and in dependent position and when a graft is upside down in thin graft you can't differentiate between the up and down and invited likes it upside down and it would also fail sometimes the wound are too big and you don't have enough graft to cover them and that's when you use the mesh graft so you basically the graph taken and made into mesh and it is used in big defects unlimited donor area and also using High oxidization wounds and in irregular bed of The Craft like this example here as you can see the graft is made into a mesh now let's talk about the flap so unlikely craft the flap is a transplantation of tissue with its blood supply and this is an example of the donor area of the flap the flap is taken from here the area over the radial artery is taken and with it the ideal artery is also taken as you can see all the way until the other one the flap uses is that it's used in covering recipient beds does have poor vascularity and in reconstruction of the full thickness of the eyelids the lips the ears the nose and the cheeks and the embodying body prominences like the heel and it is also used when it is necessary to operate through the wound as a lighter date to repair the underlying structures because we'll be graft once you operate through the graft it will fail but if the flap would not and the flap provide functional monitor unit in case of some muscle is dead or not working anymore you can use the flaps to replace that and the flaps used in controlling infection to increase deploy Supply now let's talk about the flaps types according to the location taken from so according to the location the flaps are only three types the local flaps the original flaps and the distant flaps the local flags are taken from the same site as the defect and there are many types of them there's the advancement of clubs rotational flaps and the transposition of flowers in advancement of lab the flap is Advanced forward towards the wound and rotational flaps the flybridge are rotated towards the wound like this and in transportational flap the flap is transpositioned to the to the recipient area the regional flag on the other hand are from the same region as that effect like in the arm or in the hand and the distance flaps is from another region now the flap is also classified according to the pattern of blood supply and they are classified into axial flaps and random flaps random flaps they have random plus Supply there is no well named artery is applying them but in the axial flaps there is actually a well named article in the radical of the flap and they also classified the axial flaps are also classified furtherly into Island flaps Peninsular flaps and free flaps now the flaps classified according to content also into skinny flaps muscle or mental facial control variosteal and mixed the Flies also fail same with the grafts and the causes for that is that we have intrinsic and extrinsic the intrinsic is that there is an adequate blood supply to the flap or arteriovenous shots so in both cases there is not enough blood reaching the flood and the flap dies and extrinsic factor that infection also lead to tissue damage and death and hypotension this also would decrease the blood supply to the flap compression hematoma and smoking smoking lead to the arteries being secularized and this would make the flap also fail now finally let's talk about the monitoring of the viability of the flap it is monitored by clinical tests chemical and instrumental methods the clinical test is that you examine the flap for color and temperature capillary refilling dermal bleeding atrobin absorption and histamine tests the chemical methods is that the fluorescein dye injection and the instrumental is that you check the artery of the flag by the blood ultra sound making sure that it is passing the blood well and there's also the photo flutisomography and the tissue pH po2 and pco2 and with that reach the end of this video thank you guys for watching please make sure to like And subscribe and if you want to support us more you can by subscribing to the patreon link you provided in the description of this video thank you for watching and peace