Skin cancer is one of the most common forms of cancer, making up about 40 percent of overall cases. It also has the distinction of having higher survival rates than most of its peers. Symptoms of skin cancer are clearly visible as they present themselves in the form of ulcers, discolored moles, bumps, and scales on the skin.
Treatment of skin cancer may involve removal of the affected skin. In such cases, the affected area is left with an open wound that has to be closed. Reconstructive surgery is used to restore the normal appearance of the area. The type of reconstruction depends on the location and size of the wound.
Grafts vs. Flaps
Grafts and flaps are two techniques used to close a surgical defect resulting from skin cancer treatment. Both techniques involve transplanting skin from one part of the body to another. However, the similarities end there.
Skin grafting uses a shaver to remove a layer of skin and patch it over the affected area. The skin removed is devoid of any blood vessels and merely serves a cosmetic purpose.
Skin flaps, on the other hand, are tissues that keep their blood supply intact when removed from one site (donor) and placed in another site (recipient). Flaps contain not only skin but also muscle and fatty tissues. They can be used to completely reconstruct an excision from skin cancer surgery.
Types of Flaps
Flaps are usually selected based on the most aesthetically pleasing and natural outcome. As such, there are many different types of flaps categorized based on their complexity, type, shape, and blood supply. Here are a few important types:
• Local Flaps – These flaps use skin available adjacent to the excision to close the wound. The donor area skin is cut, pulled over the recipient area, and sutured. Incisions from the surgery fade within a few weeks.
• Regional Flaps – These are more complicated than the local flaps, as they are taken from a region much farther from the wound. They are carried under normal tissues and supplied blood through a pedicle. This type of flap provides far better aesthetic results than a local flap.
• Free Flaps – These flaps are quite complicated and require a long reconstruction time. Here, the donor area tissue is completely removed from the body and reattached at the recipient site. The blood supply, which has been cut off, is reconstituted using microsurgery. A graft is used to patch the wound. Patients are monitored closely to make sure there is no problem with blood circulation and recovery afterwards.
Apart from these, there are bone flaps, muscle flaps, axial flaps, V-Y advancement flaps, fibular flaps, and many others that are used according to reconstruction requirements.
Flap Usage
In minor cases, a skin graft is enough to close the wound and reinstate the aesthetics of the defect area. A flap is necessary in the following situations:
• When the size and/or location of the defect are so large that a graft will not suffice
• When there is a risk of asymmetry, which can compromise aesthetics
• When the patient prefers a more neat and clean reconstruction
• To avoid tissue wastage during surgery
• When there may be other cosmetic implications
Set Up Your Consultation
Flap reconstruction in the aftermath of skin cancer surgery is a highly complex process. Surgeons should be able to identify the most suitable flap for reconstruction, should it be necessary at all, and discuss the same with the patient before proceeding further.
At Northwestern Specialists in Plastic Surgery, our skilled plastic surgeons are experienced in a wide variety of skin-reconstruction techniques. Contact our office and schedule your consultation today.