Introduction
Skin cancer excision and flap reconstruction is performed to remove skin cancer and reconstruct the affected area with a flap of healthy skin. This approach is commonly used for larger or more complex skin cancer cases, where a simple excision may result in significant cosmetic or functional deficits.
Indications
This procedure is indicated for patients with skin cancer, especially for those with:
- Large or aggressive skin cancers that cannot be fully removed with a simple excision.
- Skin cancers which are located in areas with limited skin laxity or critical cosmetic or functional importance, such as the face, neck, or hands.
- Cases where previous attempts at excision resulted in inadequate removal or recurrence.
- Skin cancers in areas where primary closure might cause excessive tension or distortion.
Preoperative Instructions
Before the surgery, patients will receive specific instructions from Dr Moar, which may include:
- Informing Dr Moar about any medical conditions, allergies, or medications being taken.
- Avoiding certain medications like blood thinners before surgery, as instructed.
- Fasting for a designated period before the procedure if general anaesthesia is required.
- Arranging for transportation home after the surgery.
Procedure
The procedure is either performed under general anaesthetic or local anaesthesia with sedation. Dr Moar will remove the skin cancer along with a safe margin of healthy tissue surrounding it. The excised tissue is then sent to a laboratory for pathological examination to ensure complete removal. The results usually take several days. In special cases, a frozen section may be used for a more rapid pathological examination.
After excision, Dr Moar will create a flap using adjacent healthy skin to cover the wound. Flaps can vary in complexity and may involve skin and underlying tissue. The flap is then carefully transposed and sutured into place to cover the wound defect. This process ensures a well-vascularised and healthy tissue transfer.
Postoperative Instructions
After the procedure, patients will receive postoperative care instructions, which may include keeping the surgical site clean and dry, taking prescribed medication, avoiding strenuous activities, and attending follow-up appointments.
Risks
As with any surgical procedure, there are potential risks and complications, which include infection at the surgical site, bleeding or hematoma formation, poor wound healing, flap necrosis (death of the flap tissue), nerve damage, scarring or cosmetic deformities. It is possible to have to return for further surgery if the cancer was incompletely excised, or if the cancer comes back (recurrence).
Treatment Alternatives
The treatment alternatives for skin cancer may depend on the type, size, location, and stage of the cancer. Common alternatives include:
- Simple Excision: For smaller and less aggressive skin cancers, a straightforward excision with primary closure may be sufficient.
- Mohs Surgery: A specialised procedure to remove skin cancer layer by layer, analysing the tissue for cancer cells as it is removed, allowing for maximal preservation of healthy tissue.