Plastic and Reconstructive Surgeon
Plastic and Reconstructive Surgeon
A plastic surgeon can offer specialised techniques for removal which will minimise scarring and promote healing.
Most small skin lesions can be excised under local anaesthetic in the consulting rooms unless they are in difficult areas, multiple or the patient cannot cope with local anaesthetic injections e.g. children. The procedure takes 30-60 minutes. The only discomfort will be when the local anaesthetic is injected. This may sting for up to 1 minute. After this there's a 5-10 minute wait whilst the local anaesthetic numbs the region.
Larger or multiple lesions or if they are in difficult areas (ears, eyelids and nose) may require admission to hospital for excision. Reconstruction with a flap or skin graft may be required to provide skin cover for the defect left by excision of the lesion.
An elliptical excision is the technique most often used. The ellipse usually runs along a wrinkle or skin crease line and is two to three times longer than the lesion. This means the scar will be longer than the lesion that is being removed. If the area is excised as a circle around the lesion, when the skin is sewn up it would bulge out at each end. This is called a "dog ear" and is unsightly.
If your incision is on the face, the skin is usually stitched up with nylon sutures that will need to be removed 5 to 7 days later. On other areas of the body dissolving sutures under the skin are usually used.
A skin graft is a procedure performed where a layer of skin is removed from one area of the body, the donor site, and transplanted to another, the recipient site. The skin graft has no blood supply however over the following week new blood vessels will grow into this free piece of skin and provide it with blood again. There is always a small chance that not all the skin will take (come alive again) if blood accumulates between the skin graft and the underling tissue or if infection develops.
There are two main types of skin grafts and they are:
A flap is a piece of tissue (skin, fat +/- muscle) that is still attached to the body by an artery and vein. This piece of tissue with its attached blood supply is used in reconstructive surgery by being set into the defect. There are several different types of flaps depending on where they are moved to in relationship to where they came from.
The wound is covered whenever possible with a waterproof plastic patch so that you may shower. Strenuous exercise or work should be avoided for 7-14 days afterwards to minimize bleeding or splitting open the wound.
After one week you will be seen, the dressing will be changed and/or stitches removed. The lesion will have been sent for testing (histopathology) to check what it was and that it is adequately removed. You will be given the results at this appointment. The wound will usually be covered with a further dressing or tape for another few days to weeks depending on where the wound is and whether it is fully healed or not.
Over the following months you need to massage the wound with Bio-oil or scar gel twice a day. In the first week massage the cream in very lightly to moisturize the wound. After that apply light pressure as you massage to help break up the scar tissue. We will usually arrange a time for you to return to the surgery after 4 to 6 weeks to check on how the scar is settling. At that time further scar management may be commenced if required, such as silicone gel scar patches or gel, ultrasound or a cortisone treatment to further improve your scar.
Most people scar as a fine line that is initially red but over 6-12 months becomes pale pink. On certain areas of the body they may stretch especially over the back. Scars in the head or beard line may be slightly visible as they do not have hair in them. Your scar depends on factors such as the size and site, the rate of healing, your age and genetic make-up. Some people develop a poor scar - hypertrophic or keloid
Hypertrophic scars - thick, raised, red and itchy scars. These are most common on the back, chest and shoulders. Over 1-2 years these scars improve, but they usually remain stretched or wide
Keloid scars are similar to hypertrophic scars but tend to grow beyond the edges of the original wound, producing a thick, raised lump bigger than the original wound. They may be painful and itchy. They occur more commonly in dark skinned races. They take many years to settle and often leave a poor scar. They can be treated with silicone gel patches, cortisone injections, and rarely may require reoperation with post operative radiotherapy