After the cancer has been removed
Once the patient’s skin cancer has been completely removed, there will be an area that requires healing and regeneration. Dr. DeBloom has performed tens of thousands of facial reconstruction procedures that restore the patient’s appearance and limit resulting scarring. This surgical wound is called a “defect” and can be thought of as the area in the skin that was once occupied by the skin cancer. The size of this defect depends solely on the size of your cancer.
If you have a small defect that is because your cancer was small. If you have a large defect that is because your cancer was large.
Depending on the size, complexity and location of the defect after cancer removal, a variety of treatment options may exist. These options include primary closures, flaps, grafts, and healing with no stitches. The options that are best for your specific needs will be presented to you by Dr. DeBloom.
Once a surgical option for repairing the defect has been determined, the patient will be moved to one of our sterile procedure rooms where the stitch placement will be performed. Once the procedure has been completed, all wound care instructions will be explained in detail to the patient and, when appropriate, accompanying family members as well. These instructions will also be presented in a written format to the patient. Most stitching procedures require a one week post-operative visit in our office.
Wound Care Instructions for Open Wound
Skin Graft Wound Care
Excellent cosmetic results can be obtained by simply stitching the skin edges together with sutures. Most wounds will have at least two layers of sutures. A deep layer of sutures is placed under the skin to provide strength and will dissolve over 2-3 months. There is also a visible top layer of sutures that line up the skin edges. These sutures will be removed or dissolve over 7-14 days. The final scar is a line that will fade from light pink to pale flesh colored over several months. It is longer than the original surgery site because small “darts” or skin redundancies have to be removed to prevent puckering at the scar ends.
Skin flaps are created by moving nearby healthy skin to cover a surgical wound. A skin flap keeps its own blood supply but is moved, either by a sliding or lifting motion. Like a side to side closure, there will be at least one deep layer and one superficial layer of sutures. Flaps result in a larger scar line than the original surgical site but are designed in a way to be camouflaged by the surrounding skin lines and facial curves.
A skin graft is a patch of skin taken from one part of the body (donor site) and placed over a surgical wound (recipient site). A graft is completely separated from its original location and therefore does not have its own blood supply. The donor site is allowed to heal by granulation or by placement of side to side stitches. The graft survives by close contact to the blood supply of the recipient site and is sutured into position. You can think of it like a “patch” of skin. Common areas where grafts are used are the nose, ears, fingers, inner part of the eyelid, and lower legs. A dressing is placed over the graft to protect it during the early part of healing. The skin graft may initially be a dark pink or purple color but will become lighter over time. Skin grafts require multiple follow up visits.
The skin tissue is allowed to heal itself without stitches, thus requiring no further surgery. The wound will be moist and bumpy at first and have a yellow/pink or yellow/red base. The new skin will grow toward the center and become light pink and smooth. This type of healing may take several weeks (4-6 weeks on average). The final scar is round to oval and smaller than the original surgery site.