What is a graft and what is a flap?
A skin graft is tissue completely separated from its origin (donor site) and placed over the area to reconstruct, where it develops new blood supply over the following days. It can be split-thickness — a thin sheet of epidermis and part of the dermis, usual for large surfaces — or full-thickness, which includes all of the dermis and gives better skin quality in visible areas such as the face.
A flap, by contrast, is tissue moved while keeping its own blood supply — either rotated from a neighboring area (local flap) or carried on its vascular pedicle from further away. Because it keeps its circulation, a flap can provide thickness, fill and coverage where a graft would not survive: exposed bone or tendon, weight-bearing areas, deep defects.
The graft-or-flap decision is not a catalog choice but an analysis: what needs covering, what lies at the wound’s base, what the surrounding skin is like, and what functional and aesthetic result is sought.
When is graft or flap reconstruction needed?
The most frequent indications in Dr. Arístides Arellano’s practice:
- After skin tumor removal — the most common case: closing the defect left by resection of a basal cell carcinoma or another lesion, especially on the nose, eyelids, ears and lips, where every millimeter of skin counts.
- Trauma and accidents with loss of skin or soft tissue.
- Wounds that will not close: chronic ulcers and dehiscences that failed conservative care.
- Burn sequelae — releasing contractures usually requires graft or flap coverage; the topic has its own page.
- Reconstruction after previous surgeries with incomplete results or scarring complications.
How is the reconstruction performed?
Every reconstruction is planned backwards: first the defect is defined (size, depth, which structures it exposes), then the simplest coverage that achieves the best result is chosen — the specialty’s classic "reconstructive ladder," from direct closure to graft and from there to flap.
Grafts are taken from discreet donor sites (thigh, groin, behind the ear for the face) under local anesthesia or sedation depending on extent. The grafted area is protected with a dressing that keeps it immobile during the first days, when the graft "takes."
Local flaps are designed along the neighboring skin’s tension lines, so both the defect and the donor area close with scars oriented along natural creases. Larger procedures are performed in a hospital operating room.
See the full guide: Post-surgical recovery and care.
Why this surgery belongs to the plastic and reconstructive surgeon
Graft and flap reconstruction is one of the pillars of plastic surgery training — not an optional aesthetic procedure. The judgment shows in:
- Choosing the right rung of the reconstructive ladder: not too much (a complex flap where a graft sufficed) nor too little (a graft doomed to fail over exposed tendon).
- Scar design: on the face, a well-designed flap hides in the natural creases.
- Coordination with histopathology when reconstruction follows cancer removal: clear margins first, definitive coverage second.
- The donor-site plan, which also deserves to close and heal well.
Possible risks and complications
Like all surgery, reconstruction carries risk: partial or total graft loss (from hematoma, infection or early mobilization), flap compromise, bleeding, infection, visible scars at both the reconstructed and donor areas, and color or texture differences between transferred and receiving skin — more noticeable with grafts than flaps. Some cases need secondary touch-ups to refine the result.
All surgery carries risk and requires a prior medical assessment. Results may vary according to each patient, their anatomy and their individual healing process.
Who is a good candidate?
Any patient with a skin-coverage defect: after tumor removal, trauma, burns or a chronic wound. Conditions such as diabetes or smoking do not by themselves rule out reconstruction, but they do demand more careful planning — factors reviewed at the consultation along with the wound’s state and any studies you already have.
Before and after
Most patients want to see before-and-after photographs before deciding. Out of respect for each person’s privacy, Dr. Arístides Arellano shows real cases —always with documented consent— during your in-person consultation, where you can review results from patients with a starting point similar to yours. Results may vary from patient to patient.
Approximate price in Puebla
There is no honest catalog rate for a reconstruction: cost depends on the defect’s size and depth, whether coverage is a graft or a flap, the setting (office or hospital operating room), and whether it is coordinated with a cancer excision. The quote is defined at the consultation, in writing and itemized. You can also see the practice’s reference price list for other procedures. Approximate price — the definitive cost is set at your private consultation with Dr. Arístides Arellano.
Credentials
Dr. Arístides Arellano is a plastic surgeon holding a specialty licence: he practises under a Mexican medical licence (D.G.P. 1125959) and a specialty licence in Plastic & Reconstructive Surgery (0002008), both issued by the Directorate General of Professions (DGP), which reissued his certificate of professional standing in 2025. His career began before Mexico’s present-day specialty-board system existed: he belongs to the founding generation of plastic surgery in Puebla, the second generation of a surgical tradition started in 1971 by Dr. Francisco Arellano Ocampo. Trust is verified, not promised: both licences are public and anyone can look them up in the DGP’s National Registry of Professionals.
Documented training in reconstruction with grafts and flaps
Grafts and flaps are the alphabet of reconstructive surgery: without them a large defect cannot be closed. Dr. Arístides Arellano is a plastic surgeon holding a specialty licence (cédula de especialidad) issued by the DGP, trained in the discipline at a public hospital in Buenos Aires, where reconstruction is the daily work:
- Symposium: cutaneous substance loss — Instituto Marcelo J. Fitte · Buenos Aires
- Update course: tissue expanders — XXVI Congresso Brasileiro de Cirurgia Plástica · Blumenau, 1989
- Course: Applied anatomy for plastic surgery — Sociedade Brasileira de Cirurgia Plástica — Regional do Rio de Janeiro
- Postgraduate diploma in Plastic Surgery (Argentina) — Hospital General de Agudos Dr. Abel Zubizarreta, Municipalidad de Buenos Aires · diciembre de 1989
- Fellow — International College of Surgeons — Washington D.C. · 15 de junio de 1994
Trust is verified, not promised. All 210 scanned documents —degree, licences, diplomas, publications and certificates, from 1977 to 2025— are open in Dr. Arístides Arellano’s credential archive, alongside an explanation of the difference between a specialty licence and a board certification.
Recovery · step by step
- Days 1–5Relative immobilization of the grafted area or flap; the initial dressing is left untouched. This is the critical integration phase.
- Days 5–14First dressing changes at the office; graft take or flap vitality is verified and sutures are removed in stages.
- Weeks 2–4Coverage is stable; scar care and strict sun protection of the area begin.
- Months 1–3The transferred skin matures: color and texture progressively approach the neighboring skin.
- Months 3–12Final scar maturation. If a secondary touch-up was planned, it is scheduled in this window.
Frequently asked questions
Which is better, a graft or a flap?
Neither is "better" in the abstract: they are tools for different problems. A graft covers broad, shallow surfaces; a flap brings tissue with its own circulation for deep defects or exposed structures. The right choice depends on the specific defect and is defined at the consultation.
Where is the skin for a graft taken from?
From donor sites that heal well and stay discreet: the thigh is the most common for split-thickness grafts; the groin, the crease behind the ear or the eyelid for full-thickness grafts destined for the face, because their skin better matches the recipient area.
How long does a skin graft take to "take"?
The first 5 to 7 days are critical: in that window the graft develops its new blood supply. That is why the area is immobilized and the initial dressing left untouched. Full integration and color maturation take weeks to months. Results may vary.
Will grafted skin match my skin color?
Not at first: it usually looks pinker or darker than neighboring skin, and over months it tends to blend without matching completely. Full-thickness grafts and local flaps achieve the best color and texture match, which is why they are preferred on the face.
Is reconstruction done in the same surgery as tumor removal?
Often yes — excision and reconstruction in a single operative stage. When margin analysis advises it, it is done in two stages: first confirming the lesion is completely out, then definitive coverage. The sequence is decided case by case with the pathology result in hand.
What care does the donor site need?
Simple wound care and protection: with split-thickness grafts the donor site heals on its own in one to three weeks, like a deep graze; full-thickness donor sites are closed with sutures and leave a fine line. Both follow the same rule as the reconstructed area: strict sun protection while the new skin matures.
Every case is different. Discuss yours in a personal consultation.
Book a consultation on WhatsAppEvery figure published on this site is approximate and is not a quote. Any procedure or treatment first requires a private assessment consultation with Dr. Arístides Arellano —$800 MXN, charged separately— and it is at that consultation that the definitive cost of your case is determined.
Educational content; it does not replace a medical consultation. Results may vary from person to person.