In every case in which skin is to be replaced, consideration is to be given to all the conditions existing, so that choice may be made of the best form of graft or flap for the particular repair. Thus, when the defect to be covered is on the face, a primary consideration is to ensure that the new skin will conform to its surroundings in texture, in surface level and in coloration and will incorporate imperceptibly with the skin adjoining.
While these requisites might be found in a pedicle flap raised from an adjoining area, the difficulty is that this method produces and leaves a visible disfigurement. The thin epidermic graft will not do either. It is too thin to maintain the surface level of its surroundings, and it tends to take on a brownish tint that does not conform to the rest of the face. The tubed pedicle flap,
SHEEHAN JE. THE USE OF FREE FULL THICKNESS SKIN GRAFTS. JAMA. 1939;112(1):27-29. doi:10.1001/jama.1939.02800010029006