Avoiding Skin Grafts: The Local perforator Flap in Cutaneous Defects Covering.
Sliesarenko Sergii, Badiul Pavlo, Nor Nadia, Sliesarenko Dmitro, Rudenko Oleg, Lychkata Kateryna, Nosulko Oleksiy 
Burns & Plastic Surgery Centre Dnipro.  Ukraine.

Since its creation the first dermatome of 1939  skin grafts have become the most common method of wound closure. This method has long been called the "gold standard" of skin plastic. But, after surgery by attached split-thickness skin graft, does not fully recreate the lost skin. And the increased requirements of patients for the quality of life parameters require the improvement of plastic surgery in this aspect.

 Objectives
To improve the efficiency of wound closure surgery, we can select cases where it is possible to avoid skin graft transplantation. Instead, close the wounds by the local perforator flaps, which will restore the skin to the most similar to the lost.

Methods
In the first group (25 patients), the V-Y local flaps method was used. In the second group (28 patients) the Keystone local perforator flaps were used. In the third group (30 patients) skin grafts cover was used. Evaluated the rate of wound healing, the properties of the restored skin and the patient's quality of life.

Results
All patients received complete wound healing, in the first and second groups the wounds healed 2 times faster to compare with third group and the quality of the new skin was significantly better.

Conclusion
The local perforator flaps is a versatile and reliable reconstructive option for cover small or middle size wounds. This method provides restoration of the skin similar to the lost one, considerably superior in quality to the skin restored by engraftment of skin grafts. But limitations for local flaps is such as donor-site scarring or other skin problems. We are agreement in that “there is no one single flap or modification for all situations.” Sufficient experience the plastic surgeon of these modifications can guide to the appropriate reconstruction. Traditionally, split-thickness skin grafts were still as main method for large and extensive soft tissue Reconstructions, like on circular limb wounds.

4 - Avoiding Skin Grafts: The Local perforator Flap in Cutaneous Defects Covering