Skin Cancer Reconstruction
Skin cancer removal often leaves behind a wound that requires more than a simple stitch to close. Depending on the size, depth, and location of the excision, patients may need specialized reconstructive techniques to restore both appearance and function. Golden State Plastic Surgery provides advanced skin cancer reconstruction for patients who have undergone Mohs micrographic surgery, wide local excision, or other cancer removal procedures.
What Is Skin Cancer Reconstruction?
Skin cancer reconstruction is the surgical repair of defects left after cancerous tissue is removed. The goal is to close the wound effectively and restore the area’s natural appearance as closely as possible. The right approach depends on several factors, including the size and depth of the defect, its location on the body, the type of cancer that was removed, and the patient’s overall health.
Some defects are small enough to close directly with sutures. Others require tissue to be borrowed from adjacent areas, grafted from a donor site, or transferred as a flap with its own blood supply. A plastic surgeon experienced in oncologic reconstruction evaluates each wound individually to determine the best method of repair.
Delayed Primary Closure
Not every reconstruction needs to happen the same day as the cancer removal. Delayed primary closure is a planned approach in which reconstructive surgery is postponed, typically for 5 to 20 days after the initial excision. This allows the surgical team to confirm that all cancer margins are clear before committing to a definitive repair.
Delayed reconstruction gives the wound bed time to develop granulation tissue, providing a healthier foundation for eventual closure. It also allows post-operative swelling to subside, giving your surgeon a more accurate picture of the true defect size. For patients with aggressive or recurrent skin cancers, waiting ensures that pathology results confirm complete removal before reconstruction begins.
Your surgeon can also take additional time to plan the optimal repair strategy, especially for complex or large defects. While the interim period requires diligent wound care, including bandage changes and infection prevention, the trade-off is a more precise reconstruction with a lower risk of complications.
Adjacent Tissue Transfer
Adjacent tissue transfer is one of the most commonly used techniques in skin cancer reconstruction, particularly for defects resulting from Mohs surgery. This approach rearranges skin and soft tissue from the immediate surrounding areas to fill the defect. Because the tissue comes from a nearby location, the color, texture, and thickness tend to match well.
The technique involves designing a flap pattern that allows adjacent tissue to stretch, rotate, or advance into the wound. The three main flap designs used in adjacent tissue transfer are advancement flaps, rotation flaps, and transposition flaps. Each is chosen based on the defect’s location, size, and the elasticity of the surrounding skin.
Tension control is an important part of the process. Your surgeon undermines the skin around the defect, separating it from the underlying tissue to allow it to move more freely. This reduces strain on the wound edges and lowers the risk of wound separation or distortion during healing.
The wound edges are then beveled and closed in layers to minimize scarring. Adjacent tissue transfers work best for small to moderate defects where the surrounding skin is elastic enough to be rearranged without excessive tension.
Skin Graft Reconstruction
When a defect is too large for direct closure or adjacent tissue rearrangement, skin grafting offers another option. A skin graft involves transplanting healthy skin from a donor site on the patient’s body to cover the wound left by cancer excision.
Split-Thickness Skin Grafts
A split-thickness skin graft (STSG) removes the outer layer of skin (epidermis) and a portion of the underlying dermis from a donor site, usually the thigh, abdomen, or back. The graft is then placed over the wound and secured with sutures or staples. Because only part of the dermis is removed, the donor site heals on its own within 1 to 2 weeks. Split-thickness grafts are commonly used for larger defects or areas where a full-thickness graft would not be practical.
The graft may be meshed, meaning small holes are cut into it so the skin can stretch over a larger area and fluid can drain during healing. While effective for coverage, split-thickness grafts can sometimes differ in color or texture from surrounding skin.
Full-Thickness Skin Grafts
A full-thickness skin graft (FTSG) includes both the epidermis and the entire dermis. This type of graft provides better color and texture matching because it contains the full complement of skin layers. Surgeons typically take full-thickness grafts from areas such as the groin, inner arm, or collarbone. The donor site is immediately closed with sutures.
Full-thickness grafts take longer to heal than split-thickness grafts, but they tend to produce more aesthetically pleasing results. They are often preferred for visible areas or locations where skin quality matters for function, such as near joints.
For either type of skin graft, the wound bed needs an adequate blood supply to support graft survival. Delaying reconstruction by several days can improve this by allowing the wound bed to become vascularized before grafting.
Reconstruction with Local, Regional, and Keystone Flaps
For larger or more complex defects, particularly those resulting from excision of melanoma, dermatofibrosarcoma protuberans (DFSP), or other aggressive skin cancers on the trunk, back, chest, and extremities, flap reconstruction offers a durable, single-stage option. Unlike skin grafts, flaps maintain their own blood supply, allowing them to survive in areas where blood flow to the wound bed may be limited.
Local and Regional Flaps
Local flaps use tissue from directly adjacent to the defect, remaining attached to its original blood supply while being rotated or shifted to cover the wound. Regional flaps draw tissue from nearby but not immediately adjacent areas. These may be tunneled under the skin to reach the defect while maintaining their vascular connection through a pedicle, or stalk of tissue.
Both types provide better tissue thickness and contour than skin grafts, making them well-suited for areas subject to movement and tension.
Keystone Flaps
Keystone flaps have become an increasingly popular option for reconstructing moderate to large defects on the trunk, back, and extremities. They derive their blood supply from fasciocutaneous perforators, the small blood vessels that run through the connective tissue beneath the skin.
The keystone flap is designed on the side of the defect with the greatest skin elasticity. Several modifications exist, including Type I (skin only), Type II (incorporating fascia), and Type III (double keystone flaps for very large defects). The design allows the flap to close the wound with minimal tension while providing excellent color and contour matching.
For oncologic surgery, keystone flaps are particularly valuable because they allow generous surgical margins without compromising wound closure. Patients undergoing wide excision of melanoma or DFSP benefit from reliable, immediate closure that avoids the donor site morbidity associated with free tissue transfer.
Choose the Right Approach with Golden State Plastic Surgery
The decision between delayed closure, adjacent tissue transfer, grafting, or flap reconstruction depends on the individual case. Key factors include the size and location of the defect, the type and stage of skin cancer removed, the patient’s health and healing capacity, and the functional and cosmetic priorities for the affected area.
Your surgeon will evaluate the wound, review the pathology, and discuss options with you. In some cases, a combination of techniques produces the best result.
Reconstruction after skin cancer removal is a critical part of the treatment process. The right technique can make a meaningful difference in both healing and long-term appearance. Golden State Plastic Surgery works closely with dermatologic and surgical oncology teams to provide coordinated reconstruction plans. Contact Golden State Plastic Surgery today to schedule a consultation and discuss your options.
