Skin Surgery And Reconstruction

Skin surgery and reconstruction

Most wounds created by excision of melanoma can be stitched directly closed.  Where possible, incisions are oriented to give the best scar by hiding these in the natural wrinkle-lines, especially on the face.

Where the wound in the skin is too large to suture closed edge to edge, or where doing so would cause distortion of surrounding structures, other techniques can be utilised.  Plastic surgeons have specialised training and interest in the more complicated techniques for reconstruction.

Large wounds may require reconstruction with body tissue from another site in the body.  This tissue can be in the form of a skin graft or a flap.

Skin Graft

Skin grafting involves removing a piece of skin from a part of the body that can spare it and fixing it in place where there is a large wound.  Here it receives nutrition from the underlying tissues and heals in place to provide skin over the wound. There are two main types of skin graft, Full thickness and Split thickness.  Where the skin is taken from is either stitched up, in the case of a full thickness graft, or heals in like a graze over 7-10 days in the case of split skin grafting.

Here a split-thickness graft has been used to reconstruct a large wound on the scalp from the excision of a skin cancer.  Grafts often look discoloured initially but settle in over a few weeks to very closely match the surrounding skin.


Sometimes the wound created during excision of a skin cancer is not suitable for a skin graft either for cosmetic reasons or because the wound will not allow a graft to take.  A flap may be required to fill such wounds.  A flap is a piece of body tissue taken from an area that can spare it and used to fill a deep or complex wound.

As opposed to a graft a flap takes its own blood supply with it when it is transferred from an adjacent part of the body (local flap) or from a more distant part of the body (distant flap).  Occasionally the blood supply of the flap needs to be detached and re-connected near the wound (free flap).

Local Flap

Here a local flap is used to reconstruct the wound caused by the excision of a facial skin cancer.  An advantage of using a flap is that the local tissue matches the surrounding tissue closely and usually gives a superior cosmetic result once healed in.