About Skin Grafts
When tissue is removed surgically from the face, as is done in skin cancer removal, an open wound (or defect) remains. Reconstruction (or closure)
of the defect may be done using many techniques, depending on it's size, depth, location and surrounding skin type. If the defect is superficial and in an area of tension, such as the nose, a skin graft may be used to complete the reconstruction.
A skin graft involves taking a partial or full thickness section of skin from one area (called the donor site) and placing it inside the defect (the recipient site). The skin graft is often taken in front or behind the ear, leaving a small, straight scar hidden in the natural crease. When a larger graft is required, it may be taken from the lower portion of the neck where the scar is also hidden in the natural creases of the skin. The skin graft is then trimmed to shape and sutured into the open defect. The graft may have a special pressure dressing, called a bolster, attached to it for a few days to prevent fluid accumulation beneath the graft during healing.
Following surgery, the graft will have to go through several stages of healing. The beginning stages involve reestablishment of circulation. This will take 6-7 days. During this time, the graft will appear mottled, burgundy or purple. It may also appear concave initially, but will level out on its own. The next stage of healing involves regeneration of hair, sweat and sebaceous glands. Finally, the nerve endings reconnect and pigment is reestablished. These final stages may take up to a year. Sometimes, a portion of the skin graft does not fully survive and sloughs off like a burn. In this case, the area will reepithelialize and new skin will cover the area in a short time. Often the area is treated with dermabrasion after 4-6 weeks to blend the edges of the graft with the surrounding skin. The donor site scar fades to just a scratch or disappears completely.
The advantages of skin grafts are ease of reconstruction, lack of need to place additional incisions such as with a skin flap, and lack of tension of direct closure.
The disadvantages of skin grafts are poor color match (in 50% of cases), textural and thickness differences, inability to place a supporting cartilage graft under the skin graft at the time of reconstuction, and additional donor site discomfort. Skin grafts are not usually the optimal choice as far as appearance, but there are circumstances where skin grafts are clearly the reconstruction of choice.
HISTORY 53-year-old man presents with a recurrent upper eyelid induration and margin retraction for 3 months. Punch biopsy confirmed squamous cell carcinoma (SCC) recurrence. The first SCC excision with frozen sections and reconstruction was done 12-17-13 elsewhere. Subsequently, the eyelid was treated with LN2 in 2014 for surface AK. Carcinoma recurred at the lid…Read More
History 78-year-old man with a recurrence of squamous cell carcinoma of forehead following surgery and radiation. Resection was performed in 4/2016 and radiation followed. Lesion recurred within 1 week of completion of radiation within radiation field. Originally presented with squamous cell carcinoma with perineural invasion and 4.5mm depth of invasion, arising from squamous cell carcinoma…Read More
HISTORY 63 year old man presented with a 5-year history of a lesion on the left anterior neck. The lesion was diagnosed as basal cell carcinoma and excised in 2012 , but it recurred three years ago with progressive deep scar growth. The lesion was re-biopsied in 2017 as a metatypical basal cell carcinoma with…Read More
HISTORY 93-year-old man presents with an incidentally discovered left neck mass during evaluation of a left ear SCC. Initial biopsy on 9-5-17 showed atypical fibroxanthoma. Excision of the left neck lesion with 5 mm margins on 9-26-17 revealed malignant spindle and epithelioid cell neoplasm consistent with pleomorphic dermal sarcoma. Deep and peripheral margins were…Read More
HISTORY 57-year-old woman with 40-year history of growth on right mid back that has changed in color and size. This is a 2.2cm rough plaque with variable colors. Previous biopsy done 15-20 years ago was benign. Patient has a history of BCC and SCC. Biopsy was read as a squamous cell carcinoma by a dermatologist.…Read More
A man in his thirties with lifelong h/o severe actinic cheilitis of left lower lip. Recurrent flare-ups of cheilitis have been treated as recurrent herpetic infection. Recently he has experienced worsening of cheilitis and appearance of the lesion. Biopsy found squamous cell carcinoma with perineural invasion. Lip invasion was histologically measured to be > 2mm…Read More
STAY UP TO DATE
Sign up for our newsletter!
Collaborate on a Patient
Coordinate a Mohs procedure with our surgeons. Operate at our surgery center.
PRESENT AT SCARS TUMOR CONFERENCE
SCARS Foundation Monthly Skin Cancer Conference is CME Accredited.