Plastic surgery restores form and function through reconstructive procedures, cosmetic enhancements, and body contouring.
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Basal Cell Carcinoma (BCC) is the most common form of skin cancer, often occurring on sun-exposed areas of the face, nose, and ears. While rarely metastatic, BCC can be locally destructive, burrowing deep into tissue and cartilage. Excision often leaves deep, crater-like defects that require complex repair.
The physical indication for reconstruction is the void left after Mohs surgery. These defects often involve complex contours, such as the alar rim of the nose or the helix of the ear. Simple closure is rarely an option due to the lack of loose skin in these tight, cartilaginous areas.
Squamous Cell Carcinoma (SCC) is more aggressive than BCC and can spread to lymph nodes. Excisions for SCC often require wider safety margins, leading to larger surface-area defects. These lesions frequently occur on the scalp, lips, and hands.
Reconstruction for SCC defects must account for the larger area of tissue loss. Scalp defects may require rotation flaps or skin grafts to cover the exposed skull (calvarium). Lip defects require careful alignment of the vermilion border (lip liner) to maintain a natural smile and oral competence.
Melanoma is the most dangerous form of skin cancer and requires wide local excision, often removing a significant margin of healthy skin around the tumor. This can leave large, sometimes disfiguring wounds on the trunk, limbs, or face.
The depth of the excision is determined by the thickness of the melanoma (Breslow depth). Reconstruction often involves large advancement flaps or skin grafts. Sentinel lymph node biopsy may also be performed, adding a second surgical site in the groin or axilla that requires management.
Chronic sun exposure leads to actinic damage, in which large areas of skin become unstable and prone to multiple cancers. This “field cancerization” means the skin surrounding a defect may be poor quality, thin, and inelastic.
Reconstruction in these patients is challenging because the local donor tissue is compromised. The skin tears easily and holds sutures poorly. Surgeons must often recruit tissue from further away or use skin grafts from non-sun-exposed areas to ensure a reliable repair that won’t break down.
Hidradenitis Suppurativa is a chronic, inflammatory skin disease that affects apocrine gland-bearing areas, such as the armpits and groin. It causes painful abscesses, sinus tracts, and severe scarring. The definitive treatment for severe cases is wide surgical excision of the affected skin.
This leaves massive open wounds in areas of high movement. Reconstruction involves managing these significant defects, often using skin grafts or negative pressure wound therapy (Wound VAC), followed by delayed closure. The goal is to replace the diseased skin with healthy tissue to prevent recurrence.
Necrotizing fasciitis and other severe soft tissue infections require aggressive, life-saving debridement (removal) of infected skin, fat, and fascia. This leaves patients with large, often circumferential wounds that expose muscle and bone.
Reconstruction is a significant undertaking, usually performed after the patient is medically stable and the infection is cleared. It typically involves extensive skin grafting or free tissue transfer to cover the exposed vital structures and salvage the limb or trunk wall.
Scarring from skin disease or its removal near the eye can pull the eyelid downwards or outwards, a condition called ectropion. This exposes the cornea to air and debris, leading to chronic dry eye, tearing, and potential vision loss.
Reconstruction aims to release the scar tissue and add skin to the eyelid, allowing it to close correctly. This often involves skin grafts or local flaps to lengthen the anterior lamella (skin layer) of the eyelid and restore the eye’s protective mechanism.
Excision of cancers on the lip or chronic inflammatory diseases can lead to scarring that shrinks the oral opening, a condition known as microstomia. This restricts the ability to eat, speak, and perform dental hygiene.
Reconstructive procedures, such as commissuroplasty, are used to widen the mouth opening. Flaps from the inner lining of the cheek (buccal mucosa) are advanced to recreate the corners of the mouth, restoring the functional aperture and oral competence.
Reconstruction of the nose must account for the airway. Scarring or loss of support from tumor removal can cause the nasal valve (the narrowest part of the airway) to collapse, causing breathing obstruction.
Functional reconstruction involves placing cartilage grafts (often from the ear or septum) to support the nasal sidewalls. These “batten grafts” act as structural beams to keep the airway open against the negative pressure of breathing, ensuring the patient can breathe freely.
Chronic skin ulcers, often caused by venous insufficiency or diabetes, represent a failure of the skin’s healing mechanism. These open wounds are prone to infection and malignant transformation (Marjolin’s ulcer).
Reconstruction involves cleaning the ulcer bed and covering it with a skin graft or flap. However, success depends on treating the underlying vascular issue. The surgery converts a chronic, open wound into a closed, stable surface, reducing the risk of infection and systemic complications.
Some skin diseases or previous surgeries trigger an aggressive healing response, leading to keloids or hypertrophic scars. These are raised, painful, and itchy growths of scar tissue that extend beyond the original wound boundaries.
Reconstruction involves excising the scar tissue and closing the wound with minimal tension. Adjuvant therapies like steroid injections or radiation are often used immediately after surgery to prevent recurrence. The goal is to replace the painful, unsightly mass with a flat, linear scar.
Send us all your questions or requests, and our expert team will assist you.
A nasal flap, like a forehead flap or nasolabial flap, involves taking skin from the forehead or cheek and moving it to the nose to cover a defect. This skin is chosen because it closely matches the color and texture of nasal skin, resulting in the best cosmetic outcome.
Yes, this is called scar contracture. We can perform a Z-plasty or use a local flap to release the tight scar tissue and lengthen the skin, allowing your lip to return to its natural, relaxed position.
Chronic leg ulcers often won’t heal because the edges of the skin have stopped growing. A skin graft provides a fresh biological covering that seals the wound, reduces pain, and prevents infection, allowing you to return to normal activities.
Yes, ear reconstruction is very common. We can use cartilage from your ribs or the other ear to build a framework, and then cover it with skin grafts or flaps to recreate the ear’s natural shape and contours.
This is why we wait for “clear margins” before reconstructing. If cancer does recur, we can lift the flap or graft, remove the recurrent tumor, and then re-close the area. Oncologic surveillance continues long after the surgery.
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