Skin cancer excision & reconstruction

Surgery is one of the most effective methods of treating skin cancer. This involves cutting the skin cancer out, known as surgical excision. The wound can then be sutured closed. If the wound is large or in an area where there is lack of tissue, then reconstruction may be required. This may be in the form of skin grafts or flaps. The specimen that is removed is sent for histological assessment to ensure it is completely removed.

What is a skin graft ?

A skin graft is a piece of skin that is transferred from one area of the body to another. They can be full thickness or split thickness depending on the dermal content of the skin graft. Once the skin graft has been applied to the wound, it is secured in place with stitches and a dressing and is allowed to heal. Generally this takes approximately a week. The area where the graft is harvested from is either stitched closed in the case of a full thickness skin graft, or dressed to allow to heal in the case of a split thickness skin graft.

The applied skin graft needs to gain a blood supply from the wound bed in order to survive. Occasionally the graft can either fully or partially fail. A wound infection may also occur which makes graft failure more likely. Bleeding beneath the graft may lead to the development of a haematoma, a collection of clotted blood, which can also contribute to graft failure. If the graft fails, then dressings will need to be applied to the wound to allow it to heal by itself.

What is a flap ?

A flap has its own blood supply unlike a skin graft. Flaps are useful in reconstructing defects with poor vascularity, exposed vital structures and where skin grafts are inappropriate or would lead to a poor cosmetic outcome. Flaps are also useful in reconstructing defects where post-operative radiotherapy is planned as they are less susceptible to the ill effects of radiotherapy compared to skin grafts. Flaps can be either local, regional, distant or free. A local flap is composed of tissue adjacent to the defect. A regional flap is from the same anatomical region as the defect eg. forehead flap for nasal reconstruction. A distant flap is from a different part of the body, away from the region of the defect eg. pectoralis major flap in head and neck reconstruction. A free flap is completely detached from the body and connected to vessels close to the defect to re-establish its blood supply and allow it to survive.


Society of Surgical Oncology

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