Composite Skin Graft: Procedure, Indications, and Healing

Definition

A composite graft includes skin, subcutaneous fat, and sometimes muscle or cartilage transferred as a unit. It provides bulk and vascularity for complex defects.

Indications

• Full-thickness defects with exposed bone, tendon, or hardware.
• Radiation-damaged recipient beds.
• Pressure sore reconstruction.
• Post-traumatic or post-oncologic defects requiring volume.

Surgical Steps

1. Harvest from donor site (e.g., groin, latissimus dorsi, rectus abdominis) with vascular pedicle (pedicled) or as free flap (microvascular anastomosis).
2. Prepare recipient bed: debride, ensure hemostasis.
3. Inset graft; anastomose vessels if free flap.
4. Inset skin paddle for monitoring; close donor site primarily or with split-thickness graft.
5. Postop monitoring (clinical, Doppler, implantable probe) for flap viability.

Healing and Outcomes

• Hospital stay 5–10 days for free flaps.
• Flap failure risk 1–5% in experienced centers.
• Long-term: good contour, durable coverage, sensation possible with nerve coaptation.