The use of free full thickness skin grafts in the treatment of complications of burns.

The main problem in the treatment of complications of deep burns is to cover the defects with skin of good quality. Although many regions can be covered by split skin grafts, it is important that some areas are covered with full thickness skin and subcutaneous fat in order to get an adequate cosmetic and functional result. In these cases rotation flaps or tubed pedical flaps have been frequently used in the past. Tubed pedical flaps are difficult to construct and have many disadvantages. With the aid of microsurgery it is possible to isolate free skin flaps with the vascular bundle supplying the flap with blood. These flaps can be completely removed from the donor area in one operation and can be placed onto the recipient area. After the vessels of the free flap have been anastomosed to the vessels in the recipient area, the function of the transplanted skin will remain normal. The colour of the transplant, its elasticity and its consistency and preserved. These one-stage techniques greatly facilitate the reconstruction after deep burns. In addition, the quality of the skin varies according to the site of the skin flap taken and it is thus possible to chose the type of skin most appropriate to the recipient zone. The authors describe the different types of free skin flaps, mentioning their qualities and their disadvantages. Finally, they discuss which skin flaps are most useful to cover particular skin defects.