> For the complete documentation index, see [llms.txt](https://thisispiggy.gitbook.io/my-wiki/llms.txt). Markdown versions of documentation pages are available by appending `.md` to page URLs; this page is available as [Markdown](https://thisispiggy.gitbook.io/my-wiki/02-step-2/surgery/14-general-surgery.md).

# 14 General Surgery

A surgical graft is the **transfer of tissue without its blood supply to a new location, requiring a new blood supply to form.**

Initially, the graft survives by plasmatic imbibition, or the absorption of transudate. **Capillaries begin to form 48 hours following grafting, with full vascular flow developing 7 days postoperatively**.

Surgical grafts are indicated when the patient experiences:

* **Trauma**
* **Tumor removal**
* **Burns**
* **Poor approximation of wound edges**
* **Chronic ulcers**

Split thickness skin grafts (STSG) include the **epidermis and some of the dermis, and is usually 10/1000 to 18/1000 of an inch thick**.

Full thickness skin grafts (FTSG) includes the **epidermis and dermis. The donor location requires a surgical flap to repair the extraction site.**

**Full thickness** skin grafts are used in locations **where cosmetic appearance is important** (e.g. the face) or in **areas with increased mobility** (e.g. around joints).

Split thickness **skin grafts contract more than full thickness skin grafts, making them undesirable except** when large grafts are required (e.g. large burns). They are used in cases of large grafts because of the simple healing process of the donor site.

Failure of a surgical graft may occur secondarily to:

* **Graft movement**
* **Infection**
* **Poor neovascularization**
* **Diabetes mellitus**
* **Malnutrition**
* **Smoking**
* **Corticosteroid therapy**

Graft failure may be treated depending on the extent of failure:

* **Partial loss is managed with moist dressing**
* **Complete loss requires surgical assessment**

## Flap

A surgical flap is defined as **the transfer of tissue with its original blood supply to a new location.**

Surgical flaps are indicated when:

* **The wound area is poorly vascularized**
* **The wound cannot be closed without high tension**
* **A large wound occurs in a cosmetically delicate location** (e.g. breast reconstruction)

Surgical flaps may be categorized by location of original tissue such as:

* **Simple flaps: skin that is adjacent to the wound**
* **Regional flaps: skin is found nearby, but not immediately adjacent to the wound**
* **Distant flaps: tissue taken from a distant region of the body**

Surgical flaps may be categorized by route of vascularization:

* **Free flaps have a blood supply that was reconnected microvascularly**
* **Prefabricated flaps have a blood supply connected from a distal site**

Surgical flap failure is most commonly secondary to **poor vascularization of the flap.**

Surgical flaps that have become necrosed require **surgical debridement.**