The most prevalent form of cancer in humans is skin cancer. Along with the many ubiquitous carcinogens, direct exposure to the sun for long periods leads to irreversible damage to skin cells. Skin cancer develops in response to the cumulative sun damage that a patient develops over a lifetime.
Early signs of skin cancer can be removed through non-surgical means. When the development of cancerous cells increases significantly in size, surgical methods of removal are preferred. In some cases, cells surrounding the infected regions are removed as a precaution.
But excision of the affected cells is only the first phase of treatment. The next key step is using skin reconstruction to repair the skin wound, or defect, that results from the removal of the lesion. There are numerous skin-repair methods that can be used.
Primary Repair
Primary repair is a straightforward approach for the repair of skin defects. Here, the cavity created through lesion removal is closed with direct stitches. Closing this round cavity in this fashion reduces it to a linear-looking scar. In order to stitch the wound uniformly, the incision is often elongated. Incisions are typically made along the natural relaxed lines of the face to minimize post-surgical scar visibility.
Secondary Intention
No changes are made to the skin defect during this approach, except for regular cleaning. Healing is spontaneous and can take anywhere from a month to years to complete, depending on the size of the lesion removed. Wounds that are allowed to heal on their own in this way have a lower risk of scarring and a higher skin contraction rate. Although secondary intention is not typically recommended for lesion removal from the neck and head regions, it may be chosen as a simple option for wound closure without sutures.
Skin Grafting
Grafting is the process of removing healthy skin from one part of the body to repair another area. Grafts are primarily of two types: partial-thickness and full-thickness. With partial-thickness grafts, only the topmost layer of the skin is removed for grafting. Full-thickness grafts, on the other hand, involve thicker layers of skin that are surgically removed. Repair of facial defects is generally performed using full-thickness grafts. A major advantage of grafting is that the repaired region blends well and the scar is less noticeable.
Local Flap Reconstruction
If there are unaffected skin cells surrounding the infected region, a flap of this healthy skin may be used to cover the defect. The exact technique of flap reconstruction varies depending on the nature of the defect created by the removal of the cancerous lesion. In general, a flap is created by extending the incision from the defect site to elevate the skin so that it can be rotated or repositioned to cover the area.
Local flaps are often more effective than grafting because the color and contour match more closely. Additionally, there is no waiting period for the development of a blood supply, unlike grafting, which carries a higher risk of graft failure due to limited blood supply.
Extensive facial reconstruction methods are required when a large proportion of facial tissue is affected or when the cancer has spread to underlying muscles and structures. Reconstruction is performed by transplanting tissue from healthy areas to repair the defect. Facial reconstruction is often the best option for repairing large cancer-related defects.
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Dr. Morwood has over 20 years’ experience as a plastic surgeon. He is certified by the American Board of Plastic Surgery, is a member of the American Society for Aesthetic Plastic Surgery, and has served for years as either the chief or vice chief of the Division of Plastic Surgery of Monterey.
For more information about Dr. Morwood or if you would like to schedule a consultation, please contact us here.
