Wound Care

Skin Grafts

Some wounds may be more difficult to close directly, such as one that is particularly wide. In this case, our board-certified plastic surgeon will utilize a skin graft—a patch of healthy skin donated from another area of the body—in treatment. The skin graft can be used to cover an area of the body where the skin is damaged or missing.

There are three fundamental types of skin grafts:

Split-Thickness Skin Graft

This type of skin graft commonly is used to treat burn wounds and utilizes only the topmost layers of skin. Dr. Neal Goldberg will endeavor to select a donor site that will be well-concealed while offering the best match possible with regards to size and skin color. While the skin in the donor area will regrow, the color may be a few shades lighter than the original and surrounding skin.

Full-Thickness Skin Graft

Designed for deeper or larger burn wounds and areas where movement might be a priority, such as over a joint, the full-thickness skin graft relocates a section of skin with all the layers (thus full-thickness) to provide enhanced elasticity. After healing, a thin line scar typically remains at the donor site.

Composite Graft

Some wounds require additional underlying support, such as with skin cancer of the nose, so a composite graft combines skin, fat, and, in some cases, cartilage to provide the needed structure. The donor site will have a fine, straight scar that should fade over time.

Tissue Expansion

In addition to skin grafts, tissue expansion is a method of wound treatment that offers an abundance of benefits. This procedure gently stretches the skin in the area adjacent to the wound by inserting an expander—a balloon-like device—beneath the skin. As the expander is gradually filled with a saline (saltwater) solution, the skin above begins to grow in size. The amount of time required to complete the process depends on the size of the wound to be repaired and the individual patient’s rate of skin growth.

Expanded tissue from the scalp typically can retain hair growth, so this method can be particularly effective for repairs in this region. Tissue from other areas of the body generally do not offer the same level of hair growth. Once healed, this approach often achieves very natural-looking results.

Flap Surgery And Microsurgery

The process of relocating a section of tissue is called flap surgery, and this method of microsurgery is designed to help restore the appearance and function of an area of the body that has damaged or missing skin, muscle movement, fat, and/or bone structure. There are several different types of flaps, some of which are detailed below.

Local Flap

A section of skin and tissue located adjacent to the wound, the local flap will be transplanted over the area to be repaired. By leaving one end of the tissue attached to the donor site, the flap will be able to retain the original blood supply.

Regional Flap

This type of flap utilizes tissue that is supplied by a particular artery and vein. The sustaining blood supply from the tethered blood vessel can allow the flap to require only a slim connection to the donor site.

Musculocutaneous Flap

This section of tissue also includes muscle, which can provide a significant increase in bulk and blood supply. These flaps typically are utilized in breast reconstructions to help restore the volume and shape of the breast after mastectomy. As with the regional flap, this flap will remain attached by a blood vessel.

Bone And Soft Tissue Flap

In addition to the overlying skin, this flap includes a section of bone and also carries a nourishing blood supply from the donor site.

Microvascular Free Flap

This advanced approach uses a fully detached section of tissue. The flap then can be transplanted to the area to be repaired, where each of the tiny blood vessels will be reconnected.