2. Composite Graft
Described by Konig 1887
Phase I Cut Graft Dead White
Phase II 6 Hours Post-op Pale Pink
Phase III 12 – 24 Hours Post-op Deep
“Cyanosis”
Phase IV 3 – 6 Days Graft Acquires Healthy
Color
The Wider the Surface Contact, the More Rapid
the Revascularization
68. Width Number Complete Take Partial Loss Major Loss
(Less than 20%) (None Complete)
>2.5cm 61 54 (89%) 1 6
1.5 – 2.5cm 342 318 (93%) 7 17
<1.5cm 97 93 (96%) 3 1
500 Composite Grafts 1979 - 2000
69. Etiology of Defect
Technical Changes
Over 20 Years
Skin Cancer 478
Trauma 16
Rhombergs 3
Hemangiomas 2
Congenital Nevus 1
Use of Contralateral Ear
Tongue in Groove Alar Rim
No Primary Grafts – Allow for complete
Healing , at Least 3 Months
6-0 Monocryl Dermal Sutures to
Recipient Bed to Eliminate Dead Space
70. Success Depends Upon: Essentials for Success
Optimal Recipient Bed
Graft Size
Atraumatic Handling of Graft
? Cooling
Well Vascularized Turn-down Flap
Atraumatic Tissue Handling
Cool the Graft for 72 Hours
Strict patient Cooperation
No Smoking
No Chewing
Minimal Talking
71. Disadvantages
of Flaps
Advantages of
Composite Grafts
Tendency Toward Chronic Edema
Lack of Aesthetic Definition of Ala
Often Requires Revision
Occasional Unsightly Donor Site
Scar
Usually Require Several Stages
One Stage Operation
Superior Donor Site
Patient Comfort
Superior Aesthetic Result
Does Not Preclude Flaps