A skin defect due to trauma or skin cancer can be filled by a flap of skin and fat that is adjacent to the skin defect.
The simplest way to close a defect after removal of a skin cancer or after an injury is to use stitches to oppose the wound edges as a straight line (primary closure). If there is a large amount of missing skin or the defect is in an area of limited skin laxity, Dr Kotronakis and Dr Sanki may use a flap of adjacent skin to close the wound. A skin flap is a plastic surgery term to describe a wedge of skin or fat that is designed in a shape that will facilitate its movement into the defect and result in minimal distortion of the area from which it was raised.
Dr Sanki and Dr Kotronakis will first meet you for your skin consultation at Kogarah, Miranda, Drummoyne or Newtown. During your consultation, our surgeons will listen to your concerns and goals. While flap surgery is a safe and commonly performed operation, the consultation will be performed with sensitivity to your opinions and thoughtfulness to your concerns. Any additional health problems that might affect your treatment will be identified. An examination of your skin cancer will then follow. A flap will be recommended to you if Dr Sanki or Dr Kotronakis believe that your functional and aesthetic result will be improved by using reconstructive surgery. In general, a flap will be recommended if the wound is expected to be large or in an area where primary closure as a straight line would distort your face or body. Common areas that require flap surgery are the face, scalp, leg and hand.
Dr Kotronakis and Dr Sanki perform most of their flap repairs in a licenced private hospital or in a public hospital. Flap surgery can be performed under sedation and local anaesthetic or a full general anaesthetic. Your anaesthetist will help you determine which option will be most comfortable for you.
Patients having a flap procedure to their leg will usually need to keep their leg elevated for one week after surgery to reduce swelling to the flap. This is often best done in hospital to help assist you in your care while you are immobilised. Patients having a flap repair to other parts of their body can generally go home on the same day as their surgery. It is important to organise for someone to take you home.
A protective dressing will be placed over your flap to help its healing and to keep it clean and dry. Dr Kotronakis or Dr Sanki will thoroughly explain the aftercare of your flap to ensure its good healing. Most patients will be asked to return to see our doctors for a wound check and suture removal after 5 to 10 days. After the stitches are removed, your wounds are at their most fragile and it is important to avoid sport and swimming for at least another week. The flap and its wounds become stronger over the next three months. After this, the scars will start their process of resolution and fading.
Plastic surgery is based on the principle of minimising the cosmetic and functional consequence of cancer or trauma. Dr Sanki and Dr Kotronakis will consider all options for your reconstruction and help you pick the best procedure to minimise the defect’s effect on your appearance. Our surgeons can show you pictures of other patients who have had similar flap surgery, and will also draw a picture of your expected flap reconstruction. A flap can appear obvious and unsightly straight after surgery, but usually heals with minimal contour deformity. It is normal to have bruising and swelling after surgery and this should pass after two to three weeks. Some flaps continue to stay swollen and can “pin cushion” in the first months after surgery. Sometimes massage is recommended to help reduce flap swelling and to help break down scar tissue.
Our nurses and doctors will guide and explain the role of scar management after your surgery. In general, the wound and flap are kept clean and dry for the first week. After that, Vaseline can be used twice daily on the wound edges as skin prefers to heal in moist conditions. The Vaseline also helps to facilitate removal of your sutures as it lubricates the stitches and helps to remove small scabs. Once your wound is robust and well healed, silicone scar oil or silicone scar tape will be recommended to be used on your wound. The silicone products can be purchased from our Kogarah rooms, your local chemist or online. Silicone products have good scientific evidence for improving scars. Silicone products can reduce the redness, thickness and elevation of a scar. Silicone products should be used for up to 3 months following your surgery.
Local anaesthetic is used to numb the surgical area so that you are comfortable following your procedure. Some flaps continue to stay numb after the local anaesthetic has worn off. It is usual for sensation to return to a smaller flap over the next few weeks to months. Some larger flaps may continue to have numb patches.
A skin graft consists of only a translucent thin layer of skin and must grow a new blood supply from the wound bed that it is transplanted onto. A flap has its own blood supply and is thicker than a skin graft. A local flap is taken from skin adjacent to the defect whereas a skin graft is usually taken from skin from another part of the body. A flap therefore usually restores contour and is a better colour match to the area than a skin graft. A flap requires more surgical planning and expertise than a skin graft.
Most people having a flap procedure are able to drive and return to work a day after surgery. You may feel self-conscious if you have a dressing on your face, so it is important to consider when you will feel socially comfortable to return to work. Patients having a flap to the lower limb are strongly encouraged to keep their leg elevated as high as possible for as many hours as is possible through the day. Exercise is possible once the flap is well healed eg two to four weeks after surgery.
Dr Sanki and Dr Kotronakis are Kogarah and Miranda skin flap specialists, and perform their surgery at major hospital facilities including St George Private, Kareena Private, Hurstville and East Sydney Private hospitals. We select our hospitals based on their high standards of peri-operative care and their outstanding surgical equipment.
A skin flap may sound simple but it is real surgery, and should be performed with sophisticated surgical technique for the safest and best results. It carries real risks, and as such should be considered carefully. Fortunately, skin flap surgery in Sydney is safely performed by our highly experienced surgeons.
A skin flap is only one of many potential reconstructive techniques used by specialist plastic surgeons. It is important to see a plastic surgeon who is able to offer you the very best reconstructive solution to your problem. Make sure your surgeon is able to explain why a skin flap is the most effective reconstruction for your skin cancer or trauma defect.
We recommend that you carefully consider your choice of surgeon. Unfortunately doctors without surgical qualifications beyond their medical degree are allowed to perform surgery. Your surgeon should be appropriately qualified with at least a Fellowship of the Royal Australasian College of Surgeons (FRACS), which means that they have specialist surgical training. FRACS is the standard qualification required in Australia to perform surgery in private and public hospitals.
Members of the Australian Society of Plastic Surgeons have a FRACS and specialised training in Plastic and Reconstructive Surgery, including skin flaps.
Our Sydney skin flap surgeons, Dr Amira Sanki and Dr Ilias Kotronakis are fully qualified Plastic Surgeons. They are both Australian University trained, having received Honours degree in their medical schools. They both have FRACS qualifications as Specialist Surgeons in Plastic and Reconstructive Surgery, and are members of the Australian Society of Plastic Surgeons. They both have extensive experience and training in skin graft surgery, including the most advanced and up to date techniques. They are committed to giving their patients the safest and best treatment available.
A consultation with a qualified Plastic Surgeon is the best place to get the right advice. More information on skin flaps is available online at the Australian Society of Plastic Surgeons website.