Skin grafts and skin flaps

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Why have I been referred for this treatment?

You have a skin lesion that requires an operation to remove it. Please read the information leaflet ‘Patient information for day surgery’ which you will receive with your date for your operation. This will give you information about what you need to do before coming into the day surgery department at Brighton General Hospital Dermatology Outpatients.

Do I need to do anything before coming for the surgery?

For most operations cutting the area out and stitching it up in a line may be the only treatment that is needed. However, in some cases a larger area of skin has to be removed. If this is the case, you will need a skin flap or skin graft repair. It is normally performed under a local anaesthetic.

What does the surgery involve?

Local anaesthetic is a series of small injections to the skin in order to make the area numb, so it is pain free. The needle itself pricks and the injection itself can sometimes sting for a short while. You will remain awake during your operation.

What is a skin flap?

A skin flap is a way of repairing a larger wound. To do this, a flap of skin is used. The flap is taken from very close to your wound. It is cut away more deeply than for a skin graft, but is left partly connected to its original site, and therefore to its own blood supply. The flap is then positioned over your wound and stitched in place. Because the skin flap has its own blood supply, it survives, even though it has been moved. The area alongside your wound that has been used to create the flap will be stitched closed.

The advantages are that this type of repair often looks better than a skin graft, so it tends to be used where the cosmetic or functional result is most important: near the eye or on the nose for example.

What is a skin graft?

A skin graft is a piece of skin taken from some other part of your body. A thin piece of skin is removed from the ‘donor site’ and placed over the wound. The donor site is usually somewhere where it will not be too obvious, such as behind your ear, neck or the inside of your arm. Often the skin for the graft is cut out and the donor site repaired by stitching it back together. Rarely, but sometimes, the donor site will be like a large graze, the skin will grow back quite quickly over the next few weeks.

The area where the skin graft is put will be very delicate while it heals. Often there will be a dressing or sponge stitched over the graft to apply pressure in order for the graft to heal properly. It is vital that the graft is not damaged while it is healing. You must be very careful not to knock it.

What are the risks associated with having a skin flap or graft?

On occasions some patients may experience their wound becoming infected. If this is the case you would need to take a course of antibiotics, which will be prescribed by either your GP or your consultant. This may possibly result in the area taking longer to heal and having regular dressing changes.

Will I need to take extra care after my surgery?

It is very important that you rest for at least 48 hours after your operation. You will need to avoid any activities like shopping, cycling, and dog walking or exercise, as this will push your blood pressure up and may cause your wound to bleed. Do not bend down or strain if your operation is to your head or face, and try to sleep on two pillows for the first couple of nights.

If the operation is to your leg it is important that you rest your leg whenever possible by keeping your leg raised, until the wound has completely healed.

Depending on the type of work you do, you may possibly need one or two weeks of rest from work to enable the graft or flap to heal.

What should I take if I have any pain?

We recommend regular paracetamol for pain relief. Do not take aspirin as this can increase the risk of bleeding. If you are prescribed aspirin for another condition then please check with the consultant when you can start taking it again.

What should I do if the wound starts to bleed?

It is normal to expect some oozing of blood from the wound. If you notice any bleeding, apply constant pressure with a clean cloth for 15 to 20 minutes (keep the pressure on continually). It should eventually stop, but if for any reason you are unable to stop the bleeding please go to your nearest Accident and Emergency department.

Who will remove my stitches or dressings?

After both skin grafting and flap repair, you will be asked to return a week later to the Dermatology out patients where a member of the nursing team will review your wound and / or remove stitches.

Immediate appearance

With a skin flap in the first few weeks, the skin may become raised with the healing process, but this will generally settle down on its own and should eventually appear as a fine white line. After a skin graft the area will be a dusky pink colour and appear as a dent. This will improve as blood vessels grow into the skin from underneath, but a dent will possibly always remain. You may choose to wear make-up once the wound has become dry.

Late appearance

The cosmetic appearance of the flap / graft will continue to improve for up to 18 months. Massaging a moisturiser such as E45 or Vaseline into the flap / graft twice daily for 2 to 3 months may help the healing process.

When will I know if all the skin lesion has been removed?

It takes on average four to five weeks to have the results back in the department after your operation. You may have a follow up appointment when we will tell you your results or we may write to you directly and send a copy of the letter to your GP. If after six weeks you have not heard from the department please contact the secretaries on 01273 665019.

If your results show that your skin lesion was not completely removed, you may be asked to come back to the hospital for a further operation. This means taking away the remains of the skin lesion plus a further amount of healthy skin.

Contact us:

If you have any questions please contact Dermatology Department at A Block, Brighton General Hospital on 01273 665015 or 01273 665030 and ask to speak with one of the nurses.

If you need help with information, advice or support, you can contact the Patient Advice and Liaison Service, at Royal Sussex County Hospital on 01273 696955 Ext. 4588 or 4029.

Support Groups and further information:

British Association of Dermatologists
DermNet