Reconstructive Surgery

Introduction

Reconstructive surgery is required in cases where tumors are removed from body or the body has deformity due to congenital defects or trauma. In most cases, facial reconstructive surgery is carried out when a tumor is removed from the face. Whenever a tumor is removed from the face or any other issue of deformity is addressed, reconstructive procedures become mandatory to restore the aesthetics and functionality of various parts of the face. Though the tumors which are smaller in size may heal on their own by a process known as granulation, almost all large sized tumors require reconstructive surgery.

In the article, donor site refers to the body part of the patient from which the graft is taken and the graft site is the part on which the grafting is done.

Types of reconstructive surgical procedures:-

Surgical reconstruction of the face may be done using skin flaps or skin grafts. The one thing that is common to both the procedures is that in both the cases skin is taken from the patient’s own body.

When a skin flap reconstruction procedure sis used, an incision is made near the site of the lesion and the flap is then placed on to the lesion to cover it. But the limitation with the skin flap procedure is that it can only be used for smaller lesions.

In the cases where a big tumor has been resected, generally for the purpose of reconstruction skin grafting is done. Skin grafts, as mentioned earlier, involve borrowing of skin from the patient’s body only. Skin grafting is done by taking a piece of skin and placing it at the site of the lesion. There can be two types of skin grafts; full thickness skin grafts and split skin grafts.

Full thickness skin grafts consist of not only the skin but the blood supply structures like the nerves and muscles also. Full thickness graft includes two layers of skin; dermis and epidermis. Since a large chunk of skin is taken from the donor site, the donor site is sutured. After that a split thickness skin graft is placed on the donor site to help it heal. Split thickness grafts consist of only skin components like the dermis and the epidermis. The type of the skin graft which is used depends upon to factors; the site from where the graft is to be harvested and the medical need of the patient. Split thickness skin grafts have some clear advantages. A larger area of the body can be treated with split thickness skin grafts. Also, since it is only the top layer of skin that is taken from the donor site, once the skin gets healed which take about two months, graft can be taken again from the same site.  For harvesting a split thickness skin grafts generally buttocks, upper arms and thighs are preferred. Once a split skin graft is taken the healing of the donor site takes a few weeks.

Generally skin grafting is done immediately after the tumor is removed. Skin grafting is done in the cases where there is not enough skin left to be used on the wound. This happens due to the large dimensions of the wound.

Full thickness grafts are taken after administering local anesthesia to the patient. Once the full thickness skin graft is taken the site is stitched back to close the wound. Generally full thickness skin grafts are taken from the upper arm, abdomen and inner thighs. The scars from grafting appear to form a straight line.

The grafts are kept in place by suturing them. In most patients, the healing begins within two weeks as that is the time taken by the patient’s body to accept the graft.

Precautions after the reconstructive grafting surgery is done:-

  • The skin grafts are very delicate; therefore great care should be taken to prevent any damage to the grafts.
  • The graft site should be cleaned everyday to avoid the possibility of any infection.
  • The patient should not rub the graft site nor scratch it.
  • Some pain may be experience which is normal after grafting.
  • Swelling, if any, should be treated with the help of the doctor.

Complication in the skin grafting procedure:-

Sometimes the skin graft is improperly placed or not stitched on the wound site properly. This may cause the graft to shear. If proper care of the graft is not taken, infection may occur at the graft site. Bleeding is also a complication in case of negligence. Sometimes, if the patient’s body fails to recognize and accept the skin graft, fluid may collect beneath the graft.

The skin grafts generally do not match the color of the surrounding skin completely and that is completely normal. The skin graft may be pinkish red in color once it has healed completely.


About Dr. Debraj Shome

Debraj Shome-2
Debraj Shome, MD, DO, DNB, FRCS (Glasgow), FICO (USA), MNAMS, MBA (Healthcare Management, Vanderbilt University, USA), is Consultant Facial Plastic Surgeon, Oculoplastic Surgeon & Cosmetic Surgeon at Nova Specialty Surgery, Mumbai, India..Read more

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