Skin graft vs Flap
Came across the article “Reconstruction after Excision of Hidradenitis Suppurativa: Are Skin Grafts Better than Flaps?” by Carlos Rubi, MD, MS; Antonio Martorell, MD, PhD; Alberto Pérez-Espadero, MD, which arose some questions for me.
Authors describe there a case of preferable use of skin graft compared to flap application. Pay attention that this is strongly related only to this current patient, not a recommendation for treatment at all. The case is about bilateral inguinal hidradenitis suppurativa (HS), which was first time resected succesfully and defect was restored by bilateral inguinal flaps. Flap loss appeared in the right side, and a mesh skin grafting was performed. Afterwards observation of the patient showed that there was recurrence in the left side but no recurrence at the right side, which authors explain the following way: “...skin grafting, which does not contain cutaneous appendages, may be superior to flap repair or primary closure in terms of recurrence.”
To me it was like a light bomb! What about tumour reccurence at the same site of primary tumor resection but with flap transplanted to this defect zone? Most of those patients undergo radiation therapy, but still come back with reccurent leisure. Isnt that the same story? From this side flap containing more tissue that could be as well effected (we never know exactly how far the tumor cells can spread) seems less preferable for tumor treatment. Vasculatory of skin graft leaves less chances for tumor cells to stay at the site. In order to prevent such reccurence we can check proliferation activity before surgery by PCT scan, and take into account the results during flap surgery planning, avoiding suspicous zones.
All those thoughts also lead to conclusion how important biotechnology development is, especially in those cases where tumor defect should be substituted by healthy suitable tissue. During formation of new tissue cells are under control constantly, and any mutation can be detected immediately.
Feedback welcome.
