Skin Cover

ABSTRACT

Skin is the major barrier between the body and the exterior and maintains the "milieu interieur". As skin is the best dressing it should be replaced at the earliest. There are broadly 2 methods of covering skin defects. a. Direct approximation to close clean lacerations, surgical incisions and small areas of skin loss. This also includes z-plasty. b. Transplantation, where area of skin loss is too wide to be closed directly. Transplantation includes either grafts or flaps. Grafts are split skin [thin, medium and thick] used to cover larger skin defect where bone, joint, nerves, blood vessels, tendons are not exposed baring face and hands and feet. Full thickness skin graft is used to cover defects of face, hands and feet where contraction of the graft can be catastrophic. Flaps are used where the above conditions persist and are either skin only [random pattern, axial pattern], fascio cutaneous, muscular or myocutaneous, composite, or microvascular free flaps. In extensive burns or where skin loss is extensive secondary to trauma where above methods may be inadequate, skin substitutes may be used, where available, or tissue expansion employed