Excision and Flap and Graft Repair Treatment Brighton
Dr DeGiovanni is an experienced dermatological surgeon. Smaller skin lesions seen in the clinic can be treated with cryotherapy, curettage or shave excision. These can sometimes be carried out on the same day as the consultation if the insurance company has authorised treatment. For larger lesions and treatment of some areas on the head and neck it is sometimes necessary to perform a more complicated repair and these usually need to be booked in. Current treatment times are 1-2 weeks.
Dr DeGiovanni will recommend the best treatment for you depending on the nature of the lesion to be treated and will plan your procedure to ensure the best cosmetic outcome. Unfortunately, complications can occur after any surgical treatment and Dr DeGiovanni will discuss these thoroughly with you during the consenting process.
Where possible Dr DeGiovanni will leave a simple line-shaped scar. This is frequently 3-4 times as long as the initial lesion. This is necessary to ensure that the scar lies flat ensuring a better cosmetic result.
If it is not possible to get a good result with a simple closure Dr DeGiovanni may need to borrow some skin adjacent to the wound to close the area. This is called a flap repair and will result in a larger unusual shaped scar. If the skin is borrowed from a different site it will leave a round scar the same size as the wound however this scar will be dipped and noticeable. This is called a graft repair. The donor site is either stitched together leaving a linear scar or left as a graze on the skin which will heal over the next 4-6 weeks. The chance of complications are higher with these complex procedures and antibiotics are usually prescribed for the first week after treatment. You will be asked to attend for a wound check and stitch removal at one week. Further appointments may be required depending on how you are healing.
It is important to rest after an excision, flap or graft repair as excessive exercise can cause bleeding or stretching of the scar leading to a poorer result. The majority of the scar formation occurs within the first 6 weeks. If you are intending on travelling in the 6 weeks after your treatment please let Dr DeGiovanni know.
Unfortunately scars are unavoidable with all surgical treatments. All damage to the skin creates a scar. In many cases the scar fades well. The scar can be covered with make–up once it has healed. Scars tend to be white in colour and occasionally they are dipped in the skin. Rarely, a raised scar (called a keloid or hypertrophic scar) may form. Scars can also stretch with time especially in sites where there is a lot of muscle movement. Treatment may also disturb the colouration of the skin layers resulting in a scar that is either lighter (hypopigmented) or darker (hyperpigmented) than the natural tone of your skin. The risk of discolouration is higher in darker in skin tones.
If a dressing has been applied Dr DeGiovanni will advise you how long it needs to remain in place for and whether you need an appointment for a wound check or suture removal
A greasy ointment (e.g. Vaseline) can be applied after removal of the dressing to prevent crusting. This softens the scab and helps it to lift with minimal scarring.
Paracetamol (e.g. Panadol) can be taken regularly according to manufaturer’s instructions if the area is uncomfortable.
Head and neck wounds usually need to be kept dry for the first 7 days at least. For lesions treated on the body Dr DeGiovanni applies a splashproof dressing that will tolerate a quick shower but not a long soak. After bathing, never leave a wet dressing in place. If your dressing has become wet, wash your hands and change it. A wet dressing increases your risk of infection.
Bleeding after surgery is minimal and usually controlled by a dressing if appropriate. The wound may however, ooze when the local anaesthetic wears off. If this occurs, take some clean tissues and apply pressure OVER the dressing for about ten minutes. Do not remove the dressing.
To reduce the chance of bleeding after the procedure, take it easy and avoid activities that can increase your blood pressure. Avoid alcohol for 24 hours.
The risk of infection is about 2% with skin surgery procedures. If you are concerned about how the wound is healing please contact the Outpatient nurses.
The signs of infection can be any of the following:
- Increasing pain at the site
- A pus-like discharge