Skin graft and flap reconstruction in Melbourne

Choosing a reconstruction for the wound

I assess whether direct closure is possible without excessive tension or pulling on an eyelid, lip, nostril or joint. When direct closure is unsuitable, a graft or flap can provide coverage. A larger reconstruction is not automatically preferable: each option has different scars, healing requirements and limitations.

Skin grafts

A skin graft is skin taken from another part of the body and placed on the wound. It initially relies on the wound bed to develop a blood supply. Full-thickness and split-thickness grafts have different uses, and donor-site selection considers skin quality, colour, thickness and the size of the defect.

A graft creates a second wound where the skin is taken. Dressings help protect the graft while it heals. Differences in colour or contour, contraction and partial or complete graft loss are possible. Some exposed structures do not provide a suitable bed for a graft and may need flap coverage.

Local flaps

A local flap moves nearby tissue into the wound while retaining a blood supply. It may be advanced, rotated or transposed according to the available skin and the shape of the defect. Local tissue can provide a useful match, but the scars extend beyond the original wound and the movement of tissue must be planned to avoid distortion.

Regional flaps

A regional flap brings tissue from a neighbouring area using a defined blood supply. It may provide coverage where local tissue is insufficient or unsuitable, or where deeper structures need protection. Depending on the flap, more than one operation may be needed, including a later procedure to divide an attachment or refine the repair. The donor site also has its own recovery and functional considerations.

Recovery and trade-offs

I explain the expected scars, donor-site care, dressings and restrictions for the reconstruction being proposed. Risks include bleeding, infection, fluid collection, delayed healing, graft or flap loss, altered sensation, distortion, stiffness and further surgery. Smoking and some health conditions increase healing risks. The final contour and scar appearance evolve over months; no reconstruction restores skin without a scar.

For related information, see BCC , SCC and melanoma .

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