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Reconstructive surgery helps restore the structure and appearance of the body. Skin or tissue reconstruction may be necessary after surgery to remove a tumour. A skin graft or skin flap may be used to repair defects at a surgical excision site or to cover wounds. Skin reconstruction may be used in the treatment of skin cancer, bone cancer or soft tissue tumours.
A skin graft is a piece of skin taken from one part of the body (donor site) and placed over the area where the cancer has been removed.
There are different types of skin grafts:
- A partial thickness skin graft uses the epidermis and part of the dermis layer. Skin is usually taken from the thigh, buttock or upper arm. Skin will grow back in this area.
- A full thickness skin graft uses the epidermis and the full dermis layer. Skin is usually taken from the neck, behind the ears or the inner side of the upper arm. The skin edges of the donor site are stitched together to heal.
How a skin graft is done
A skin graft is often done at the same time as the removal of the tumour. It is done under local or general anesthetic, often by a plastic surgeon.
- A thin sheet of skin is removed from the donor site, placed over the area that needs to be covered and stitched in place.
- A dressing is placed over the grafted area and is left in place while the graft heals (usually 5–7 days).
- The donor site will also be covered in a dressing to protect it from infection. The donor site takes 1–2 weeks to heal, depending on whether a full or partial thickness skin graft was taken.
- The person can usually go home the same day. If the grafted area is on a limb, it is important to keep the limb elevated as much as possible to prevent swelling and reduce pain.
- The area where the skin graft is placed will be very delicate while it heals. It is important that the graft or flap is not damaged while it is healing. The person may need to avoid any exercise that might stretch or injure the graft for the first 2 weeks to allow the graft to heal properly.
A skin flap is a more complicated reconstructive procedure that is used to repair large surgical defects or when cosmetic results are important, such as on the face.
A skin flap is a thicker piece of tissue with its own blood supply. It is taken from very close to the wound. It is cut away more deeply than for a skin graft, but blood vessels are left connected. It is positioned over the wound and stitched in place.
A free flap uses a piece of tissue that has been completely removed from the donor site and moved to the site needing repair. A free flap requires microvascular surgery to connect the very small blood vessels of the flap to the vessels of the wound site.
Side effects can happen with any type of skin reconstruction, but not everyone has them or experiences them in the same way. The side effects are similar for both skin graft and skin flap surgeries. Side effects will depend mainly on the:
- type of surgery
- site of the donor tissue
- person’s overall health
- People who are diabetic, obese or who smoke may have more side effects.
- effect of other cancer treatment
- There may be a higher number of complications in people who have had radiation therapy to the transplant area.
It is strongly recommended that people who smoke stop at least 3 months before and 1 month after having a skin graft or skin flap surgery. Smoking affects blood flow to the skin and underlying tissues, which can lead to infection, delayed healing and increased risk of tissue death (flap necrosis).
Side effects can happen any time during, immediately after, or a few days or weeks after surgery. Most side effects go away after surgery. Late side effects can occur months or years after surgery. Some side effects may last a long time or be permanent.
It is important to report side effects to the healthcare team.
Some potential side effects of skin reconstruction include:
Pain often occurs because of trauma to the tissue during surgery. Nerve pain may occur after surgery is done on tissues close to the nerves. Nerve pain can appear long after surgery is over and may last a long time. Pain-relieving medications are used to control pain. It may take time for pain to decrease after surgery, depending on the procedure done and how the person heals or tolerates pain. Check with the doctor if pain does not go away or pain medications do not relieve the pain.
Some swelling may occur, depending on the area treated. The area may be very delicate when it heals. It is very important that the area where a skin graft or skin flap was done is not damaged while it is healing.
A small amount of bloody drainage may be expected after surgery. Report large amounts of blood to the doctor or healthcare team.
Some people may develop a wound infection after surgery. This is not a common side effect, but it can potentially occur after any type of surgery. Antibiotics may be used to help prevent or treat an infection.
Tell the doctor or healthcare team about signs of infection, such as redness, pus or foul-smelling drainage, increased swelling or tenderness at the treatment site and increased temperature (fever).
Both the grafted and donor areas will develop scars. These should gradually fade and heal with time.
The edges of a wound are usually held in place with stitches until the incision heals. The edges of the wound may separate after surgery (dehiscence). Tell the doctor if this happens.
In rare situations, the graft may not heal and the tissue dies. Another skin graft surgery may be done to replace the dead tissue.
In rare situations, the flap may not heal and the tissue dies. This can occur if there is a poor blood supply to the flap. Additional surgery may be done to try to repair the flap. If the surgeon cannot restore blood supply, the flap may have to be removed. Another skin flap surgery may be done to replace the dead tissue.