Müller R P
Dermatologische Abteilung des Kreiskrankenhauses Lemgo.
Z Hautkr. 1988;63 Suppl 2:35-40.
The considerations of defect-closure in skin surgery are associated with the question--flap or graft? Different areas and conditions require individualized approaches to reconstruction. A great variety of ingenious flaps and the new method of skin-expander promote and favourise these techniques in surgical defect closure. Anyway the different grafts are still main-topics in skin surgery. Generally there exist three types of grafts. The split-thickness skin grafts, in its various modifications, are useful for functional closures of defects, while full-thickness skin grafts give better cosmetic results. The composite graft, containing epidermis, full dermis and cartilage, fits for reconstruction of contoured defects at the nose and ear. The nutrition of this special graft is limited by the contact-periphery between graft and defectborder. In contrast the survival of the other types of grafts depends on the undersurface, the degree of granulation tissue in the wound bed. The attention of many technical details, the skillness of the surgeon and some artistic considerations are the guarantors of successful grafting and of good cosmetic results.
皮肤外科手术中缺损闭合的考量与一个问题相关——皮瓣还是植皮？不同的部位和情况需要个性化的重建方法。各种各样巧妙的皮瓣以及皮肤扩张器的新方法推动并有利于这些技术在手术缺损闭合中的应用。无论如何，不同的植皮仍然是皮肤外科的主要话题。一般来说，存在三种类型的植皮。不同改良形式的中厚皮片，可用于功能性缺损闭合，而全厚皮片能带来更好的美容效果。包含表皮、全层真皮和软骨的复合植皮，适合用于鼻和耳轮廓性缺损的重建。这种特殊植皮的营养受植皮与缺损边缘接触周边的限制。相比之下，其他类型植皮的存活取决于其下表面，即伤口床肉芽组织的程度。对许多技术细节的关注、外科医生的技巧以及一些美学考量是成功植皮和良好美容效果的保障。
