Skin grafts and skin flaps

You have a skin lesion that requires an operation to remove it. Please read the information leaflet ‘Patient information for day surgery’ which you will receive with your date for your operation. This will give you information about what you need to do before coming into the day surgery department at Brighton General Hospital Dermatology Outpatients.

For most operations cutting the area out and stitching it up in a line may be the only treatment that is needed. However, in some cases a larger area of skin has to be removed. If this is the case, you will need a skin flap or skin graft repair. It is normally performed under a local anaesthetic.

Local anaesthetic is a series of small injections to the skin in order to make the area numb, so it is pain free. The needle itself pricks and the injection itself can sometimes sting for a short while. You will remain awake during your operation.

A skin flap is a way of repairing a larger wound. To do this, a flap of skin is used. The flap is taken from very close to your wound. It is cut away more deeply than for a skin graft, but is left partly connected to its original site, and therefore to its own blood supply. The flap is then positioned over your wound and stitched in place. Because the skin flap has its own blood supply, it survives, even though it has been moved. The area alongside your wound that has been used to create the flap will be stitched closed.

The advantages are that this type of repair often looks better than a skin graft, so it tends to be used where the cosmetic or functional result is most important, near the eye or on the nose, for example.

A skin graft is a piece of skin taken from some other part of your body. A thin piece of skin is removed from the ‘donor site’ and placed over the wound. The donor site is usually somewhere where it will not be too obvious, such as behind your ear, neck or the inside of your arm. Often the skin for the graft is cut out and the donor site repaired by stitching it back together. Rarely, but sometimes, the donor site will be like a large graze, the skin will grow back quite quickly over the next few of weeks.

The area where the skin graft is put will be very delicate while it heals. Often there will be a dressing or sponge stitched over the graft to apply pressure in order for the graft to heal properly. It is vital that the graft is not damaged while it is healing. You must be very careful not to knock it.

On occasions some patients may experience their wound becoming infected. If this is the case you would need to take a course of antibiotics, which will be prescribed by either your GP or your consultant. This may possibly result in the area taking longer to heal and having regular dressing changes.

It is very important that you rest for at least 48 hours after your operation. You will need to avoid any activities like shopping, cycling, and dog walking or exercise, as this will push your blood pressure up and may cause your wound to bleed. Do not bend down or strain if your operation is to your head or face, and try to sleep on two pillows for the first couple of nights.

If the operation is to your leg it is important that you rest your leg whenever possible by keeping your leg raised, until the wound has completely healed.

Depending on the type of work you do, you may possibly need one or two weeks of rest from work to enable the graft or flap to heal.