Skin grafts and local flaps.

Expedited healing of skin wounds is essential regardless of surgical specialty. Any skin deficiency will thwart this basic intent, and an alternative must be sought. The autogenous skin graft or local flap has long had a major role in satisfying this objective. Various forms of autogenous skin grafts are to be differentiated from local flaps, primarily on the basis of vascularization. The indications for either, their surgical anatomy, harvest techniques, and limitations, including pitfalls, need to be outlined. Skin grafts are the simplest means to restore skin integrity. If skin grafts are contraindicated, a flap may be essential. For this purpose, the "top ten" local "workhorse" flaps are briefly described in this article. Accompanying videos further elaborate the requisite surgical anatomy and harvest techniques. As a problem-solving specialty, it is incumbent upon us to first prevent, then be able to provide rapid, efficient, and efficacious healing of, any surgical wound, iatrogenic or otherwise. Skin grafts and local flaps are fundamental elements for achieving this goal when healing by primary or secondary intent is not possible. Whether one is a "reconstructive" or "aesthetic" plastic surgeon, knowledge of these basic tenets will ensure maintenance of competency.