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Flaps, Grafts and skin cancer

Skin flaps and grafts are sometimes needed to help repair a wound following skin cancer surgery. Flaps and grafts are used if the skin cancer is large, and if the surrounding skin is difficult to move in order to close the surgical defect. Placing less tension on the wound results in better healing times, and less scarring. Flaps and grafts are commonly used for larger skin cancers on the nose, ears, temples and lower legs.

Important facts on flaps, grafts and skin cancer

  • Larger skin cancers will necessitate a larger wound defect
  • Large wounds are difficult to close with a simple closure
  • Flaps and grafts have the advantage of closing large wounds with less tension
  • This results in quicker healing times, better healing, and overall better scar results- if performed correctly
  • Skin cancers on the ears, nose, temples-forehead areas, and lower limbs are commonly closed with either a flap or a skin graft
  • Flaps and grafts are more complicated closures, and extra time and care will be need to perform and recover for the surgery

What is a skin flap and when is it performed?

skin flaps for cancerSkin flaps are commonly used to close wounds from excisions of skin cancers. Most skin defects can be closed with normal elliptical excisions, however if the defect is large or if important cosmetic issues arise, we may elect to use a skin flap.

 

Skin flaps are geometric movements of skin from adjacent areas designed to close a defect. The type of skin flap used will depend on many factors including the size of skin cancer, and how much skin needs to be mobilised.

 

Common areas for skin flap skin cancer surgery include – the temples, nose, ears, forehead, and sometimes the lower legs.

What types of skin flaps are there for skin cancer surgery?

using flaps skin-cancerFlaps can be described according to the geometry or shape of the flap. Some flaps are complex, some are simple.

 

Flap types include-

  • A to T flaps
  • V to Y flaps
  • Transposition flaps
  • Rhomboid Flaps
  • Advancement Surgical Flaps
  • Double complex advancement flaps
  • Subcuttaneous flaps
  • Mycuttaneous skin- muscle flaps
  • Burrows Flap and Graft combinations

The type of flap used will depend on many factors including the location of the skin cancer defect, the movement of skin, and important cosmetic structures.

How will I know if a flap is needed to close the wound?

skin cancer flapYour skin cancer doctor will know if a flap is needed prior to surgery and will discuss with you the implications prior to the procedure.

 

Flaps are used if the skin cancer defect is large, or if too much skin pull is used to close the wound, or if the skin cancer is close to important structures.

What types of skin grafts are there for skin cancer?

skin graft skin cancerSkin grafts can either be split thickness or full thickness grafts.

 

Full thickness skin grafts are often used to repair defects on the nose and ears.

 

Spilt thickness skin grafts are used to repair larger defects on the scalp, and lower limbs.

 

Donor sites are areas where the skin graft is harvested. Most common donor sites for the full thickness skin grafts include the front part of the ear, the collar bone area, and the back of the ear.

 

Split thickness grafts are usually taken from the upper thigh, or the back of the upper arm.

How will I know if a graft is needed to repair my wound?

skin grafts brisbaneYou skin cancer specialist will discuss the possible need of grafts PRIOR to surgery. We can tell if you will require a graft to close the wound as this is dependant on –

 

  • The size of the skin cancer
  • The location of your skin cancer
  • The type of skin cancer
  • How mobile your skin is in that area

How long does it take for a skin graft to heal?

Healing times range from 9-21 days, depending on the type of skin graft, the location of the graft and other factors, including your general health and circulation.

 

Full thickness grafts on the nose and ears heal the fastest.

 

Split thickness grafts on the lower legs in elderly patients take the longest to heal.

 

Donor sites (from where the graft is harvested) take between 5 days (full thickness donor site) to 3 weeks (split thickness graft) to heal up.

Can scars following flap and graft surgery be improved?

skin cancer scarsYes. Most scars will improve with time, however skin cancer doctors, Plastic Surgeons and Dermatologists will often work in with Laser Dermatologist to help improve scars even further.

 

Laser surgery can help improve the colour and texture of skin grafts and flaps. Red areas can be treated with the V Beam Vascular laser, whilst scar lines and contours can be evened out with several types of lasers, including the Erbium ProFractional Sciton laser, the CO2 CORE laser, or Fraxel lasers.

 

Most scars can be improved by 30-90% with a combination of laser techniques. Your doctor will refer you to a laser dermatologist if scar revision is needed.

 Read more about scar revision following surgery