Skin Flap Repair

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Wounds are created in the skin when skin cancers are removed such as following Mohs surgery. We prefer to repair those wounds by simply suturing the wound edges together which is called a side-to-side closure or complex closure. Sometimes the wounds are too large for this type of closure and need to be treated differently. How we choose to close those wounds is determined by various factors including its size, location on the body, patient preference, the patient’s underlying health and whether there is sufficient adjacent loose skin to stretch and rearrange into the wound.

After your skin cancer is removed and the wound is created, your surgeon will discuss the various options available and you will decide together which option to choose. One of the ways a larger wound can be repaired is with a skin flap. A skin flap is when looser adjacent skin is stretched and rearranged to cover the wound, but remains attached to the adjacent skin. Patients often wonder what the difference between a skin flap and a skin graft is. A skin graft is when skin from a completely different location on the body is removed and used to cover the wound by suturing it into the defect. In those cases removing the graft also leaves a wound and that wound will need to be repaired as well.

This discussion is limited to skin flaps. There are many different types of skin flaps. These flaps are given names which are based on various factors including the flap shape, such as a rhombic flap, or the motion which is used to move it into place, such as an advancement flap or rotation flap. The surgeon decides which flap type to use based on many factors, but most importantly which flap will allow the repaired area to function as normally as possible as well as give the best cosmetic appearance. How successful the surgeon is at accomplishing these goals will depend on the surgeon’s training, judgment and experience. At SBC, our Mohs Surgeons are highly experienced in making these decisions.

Skin flap repairs are routinely performed in our offices and done under local anesthesia. This is safer than undergoing general anesthesia, which carries its own risks. Sometimes patients become very nervous thinking about undergoing Mohs surgery to remove their skin cancer and nervous anticipating whatever surgery they may need to repair the wound created by Mohs surgery. At SBC, we are happy to prescribe an anti-anxiety medication that you may take the night before the surgery to help you sleep and the morning of surgery to help control your anxiety. These medications may make the procedures more comfortable for you.

We will explain how to take care of the wound after your surgery. We understand that most patients are somewhat stressed at this point and may have trouble remembering any instructions. You will also be given written instructions. All wounds drain and may require bandage changes daily. Mild bleeding can also occur following this type ofsurgery. If bleeding should happen, apply direct, constant pressure without stopping for 20 minutes. If the area is still bleeding after pressure then call the office, even if it is after regular office hours. You will always be able to reach one of us.

You can expect some mild discomfort after the local anesthetic wears off. Usually plain Tylenol is sufficient to control the pain. Swelling and bruising are common after this type of surgery and should resolve in 2-3 weeks. Skin cancers can often involve the nerves of the skin and it may take as long as a year or two until normal sensation returns. It is possible that the area may stay numb permanently. Also, the skin area that has been treated often feels tight. This tightness improves after several weeks to months. Anytime a skin cancer is treated, no matter what method, a scar always occurs. We will try to give you the best cosmetic result possible. We are very experiencedsurgeons.However, the final result depends on numerous factors, not just the surgeon’s experience and technique. The result will also depend on your underlying health, the type of skin you inherited, how much sun damage you have on your skin and how well you follow the post-operative instructions you are given. Scarsalways improve with time, but the maximum improvement may take as long as 1-2 years.

Rest assured we will always be available to you should you have any questions or develop problems.

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