Compromised skin grafts and skin flaps


Surgeons use skin grafting and skin flaps to close or cover wounds. A skin graft is the transfer of a portion of the skin, without its blood supply, to a wound. A skin flap is the transfer of one or more tissue components, including skin, deeper tissues, muscle and bone. Compromised skin grafts and skin flaps can result from an insufficient oxygen supply to the tissue.


The symptoms of compromised skin graft or flaps include pain, bluish discoloration and coldness of the area which has inadequate blood supply. There may be loss of sensation as well.


Skin grafts survive by getting oxygen and nutrients from the underlying wound. They depend on a new blood supply forming from the wound to the graft. When the wound bed does not have enough oxygen supplied to it, the skin graft will at least partially fail.

Skin flaps also require oxygen and nutrients to survive. The outer, visible portion (usually skin) is furthest from the source of blood supply for the skin flap. This is the area most likely to be compromised by inadequate oxygen. Factors such as age, nutritional status, smoking, and previous radiation result in an unpredictable pattern of blood flow to the skin. Oxygen loss can be caused by previous radiation to the wound area, diabetes and certain infections.