Cancer Reconstruction

Cancer Reconstruction

Contents


Introduction to Cancer Reconstruction


Removal of a skin cancer, leaving a significant defect in the face, is a frightening experience. It is wonderful to have the cancer removed, but now what? We are specialists in repairing the delicate structures of the face and can lead you through this process with a caring hand. It will take some time to heal, but you will heal.

There are so many options: secondary intention healing, primary closure, skin grafts, local flaps, interpolated flaps. We will advise you as to which repair will be best for you. Some procedures may be safely performed in the office (no facility fee), while others are better undertaken at the surgery center.

Approaches & Techniques


Secondary Intention Healing

This refers to allowing the area to heal on its own with just local wound care. In some areas, this may be a great option. However, as a wound heals, it pulls in all directions, and in some parts of the face, this may cause distortion, asymmetry, and possible functional problems.

Primary Closure

Closing a wound side to side, if possible, is often preferred. However, in order to do this some extra incisions often need to be made. Also, in many cases this is not an option because the skin will not stretch without causing distortion elsewhere.

Skin Grafts

In this procedure, we take skin from another part of the body and place it like a patch over the wound. The skin is completely disconnect the skin from its blood supply and must grow a new supply wherever it is transplanted. For this reason, the graft must be ultra-thin in order for new blood vessels to grow into it. This limits the usefulness of this procedure to wounds that are shallow or in concave areas. A major drawback is that the skin is often very unlike the skin that was originally in the wound, so it may appear patch-like for a long time.

Local Flap

A local flap allows direct movement of adjacent skin to close the wound. Similar to primary closure, extra incisions are required. The difference with primary closure is that the adjacent skin is often rotated or advanced in such a way that the direction of pull is shared in many directions, leading to less risk of distortion. This is often the best closure technique because it replaces the wound with "like tissue".

Staged Flap

A staged flap uses advanced techniques to "jump" tissue from one area to another. Usually the wound is in an area that is not well-reached by or is too large for a local flap. A pedicle of tissue is left in place for about 3 weeks before being removed, thus requiring another minor, in-office procedure. A dressing is placed over the pedicle to conceal it during this time. Examples of this are the forehead flap and nasolabial island flap.

Planning Your Procedure


The Consultation

During the consultation, we will review with you the various options for taking care of and repairing your wound. We will also review your medical history and the history of your current concerns. We will examine your wound and the adjacent areas to determine the best repair for you.

Duration of Surgery & 
Anesthesia Options

Reconstruction procedures usually take 1 to 3 hours, depending upon the extent. For healthy patients, many of these procedures may be performed in the office under local anesthesia. For those with major heart and/or lung issues, we perform the procedure at the surgical center, for the patient's safety.

Incisions

Incisions will vary according to the repair method. We do our best to conceal incisions in natural creases and wrinkles. 

How It's Done

The "moved" or transplanted tissue must first be released from the surrounding tissue. Deep absorbable stiches are then used to take up the tension of the repair. This minimizes widening of incisional scars. The skin is then usually closed with a combination of absorbable and nonabsorbable stitches.

Recovery

The typical at-home recovery time is 5-7 days. Immediately after surgery, light compression taping may be used to reduce swelling at the surgical sites. The compression taping is removed in 1-3 days. All stitches dissolve or are removed in 1 week.

Pain

The first night after surgery, you will feel a dull ache and tightness around the incision sites. Everyday thereafter, any discomfort will reduce significantly. It is normal to take opiate medication as needed up to a week after surgery, but most transition to regular Tylenol within the first week.

Swelling & Bruising

Swelling and bruising are expected and mostly subside in the first 2 weeks. Most bruising may be concealed with cover-up as it gradually fades. On average, 90% of the swelling subsides by 6 weeks after surgery, but it will take about 6 months for the incisions to feel soft again. In the end, all swelling and bruising will diminish.
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