What is Flaps and skin grafts?

When tissue needs to be removed, the hole created either needs to be closed with neighbouring, adjacent skin or distant skin (i.e skin from a different location). The distant skin can bring its own blood supply; known as a flap, or it can be transplanted without a blood supply, making it a graft. Grafts require the receiving site to grow a new blood supply. The aim of reconstruction is to close the hole with the best possible cosmetic match of skin and/or contour correction. This is most complex where there is an insufficient amount of skin to use, especially in the face and following MOHs surgery for skin cancer.

What are the non-surgical and surgical options available?

Once a hole has been created, it is possible to leave the wound open to heal naturally – this is called healing by secondary intention and is based on the premise that all wounds heal eventually with the correct dressings and environment. However, there are some disadvantages to this approach and the wound often takes a long time to heal and leave poor scaring. Surgical reconstruction enables ‘primary intention’ wound closure and can be designed to maximise the cosmetic result. Skin grafting is the simplest form of reconstruction when the edges of the wound cannot be brought together with sutures directly. Skin grafts can be full or partial thickness depending on how they are collected. Skin flaps can be thicker than skin alone and occasionally include fat and muscle. They heal within a week. Skin graft donor sites usually heal within the same time frame as the reconstructed area.

How long do the results last for?

Once healed, the area will usually be swollen for several months while new lymphatic channels form to remove excess fluid. Scar maturation progresses for 12-18 months and steps can be taken to reduce its appearance and to ensure the area heals properly. Once complete, the results usually last for life (subject to the normal ageing process and any fluctuations in weight or in the case of children, growth).

What are the risks?

With the use of skin grafting techniques, the major risk is skin graft loss, if it fails to survive the transfer. Most commonly if this occurs, it is partial (10-30%). If infection complicates the recovery period, 100% of the graft can be lost. Occasionally the donor site may take longer to heal and this is more common in thin or aged skin. Any scar can become unfavourable, especially if healing is complicated or prolonged. Hypertrophic or keloid scars are more common in certain skin types, whilst infection and bleeding are risks of any surgery. Scars can become tender where previously they were not and there is always the small risk of making things worse.

What are the success rates?

95% of cases result in complete resolution of the problem with no recurrence.

How much does the surgery cost?

The indicative prices below include the surgical fee, any anaesthetic used and the associated fees from the consultant administering this, in addition to the hospital fee and all tests and follow up. An accurate breakdown and a detailed quote will be given following the initial consultation.

From £1800 for skin grafts under local anaesthetic

From £1,500 for local flaps under local anaesthetic

From £3300 for reconstruction under general anaesthetic

What general advice is there?

Elevation of the reconstructed area reduces the onset of swelling and speeds up recovery, in addition to minimising the risks of complication.