The use of skin flaps for wound reconstruction

Although many wounds are amenable to simple closure by apposition of wound edges, this is not always possible, either because the wound is too large, or because apposition would result in distortion of the sutured skin, leading either to poor cosmetic outcome, or to poor function. An example of the latter would be removal of a mass near the eye, where simple closure may lead to distortion of the eyelid. In other cases, direct closure of a wound may be possible only by suturing the wound edges under tension. Tension is to be avoided in any surgical repair, as it reduces the likelihood of wound healing. Pulling wound edges together under tension results in stretching and narrowing of blood vessels, thus reducing blood supply to the wound edges. Tension also reduces the migration and division of fibroblasts and epithelial cells. Judicious use of walking sutures, or other tension-relieving sutures, can reduce a certain amount of tension at wound edges, but where a large skin deficit exists (or in regions of minimal ‘spare’ skin, such as on the limbs), there may just be too little skin to stretch over a wound. Options for enabling closure of a wound include: