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Reconstruction after BCC surgery – full thickness skin graft

After surgery for your basal cell carcinoma, the wound may not be able to be closed directly or with a local flap. In this case, a full thickness skin graft might be needed.

 

What is a full thickness skin graft?

As the name suggests a full thickness skin graft uses the entire thickness of the skin, unlike a split skin graft that only uses a shave of the top layer of skin. The full thickness skin graft is taken by cutting a piece of skin out, and stitching the wound closed. The graft is then put in place on the wound from the basal cell carcinoma surgery.

 

Where is a full thickness skin graft taken from?

The area that a graft is taken from is known as the ‘donor site’. The areas behind the ear, the neck, collar bone, upper arm, and groin crease are commonly used donor sites for taking the full thickness skin graft from.

 

Is a full thickness skin graft painful?

The area that the graft is taken from (the donor site) can feel a little sore and bruised, but this usually calms down after 2-3 days. The graft area itself also usually feels a little sore for just a few days.

 

Does a full thickness skin graft leave a scar?

The area that the graft is taken from will usually leave a line scar that can be a little red for a few months. It then fades gradually, and will usually become a pale scar. Rarely a hypertrophic scar can occur, whereby areas become red and raised.

 

How is a full thickness graft attached to the wound?

Sometimes, special skin glue is used to hold the skin graft into place, but usually stitches are used. These might be dissolving, non-dissolving, or a combination. Additionally, stitches might be used to hold a dressing onto the graft, to help stop it being moved or damaged while it heals.

 

How does a full thickness skin graft work?

At first, the skin graft is kept alive by fluid from the wound bed. After a few days, new blood vessels grow to the graft and help blood to start flowing through it. This is usually fairly established after just 4 or 5 days. Over the next few weeks and months, the skin graft becomes more robust and strengthens. Scar tissue can also be laid down in the area though, and the graft can start to contract (shrink).

 

What does a full thickness skin graft look like?

Once healed, a full thickness skin graft will look quite red at first, and then will begin to fade after a few months. In the end, the graft can sometimes look quite pale, and the texture and colour match may make the graft look like a ‘patch’ of skin.

The skin graft is a thin piece of skin, so it drapes inside a wound instead of filling it; the area can therefore have a ‘dented’ appearance. In a shallow wound though, a full thickness graft can sometimes match the depth of wound and so give a good contour match.

Over time, a full thickness skin graft can shrink (contract), making it look uneven and bumpy. Sometimes, this shrinkage can affect nearby areas such as eyelids, and further surgery to release this contracture might be needed. The chances of this are less than with a split skin graft though, which is why, for areas such as around the eyelids, a full thickness graft is usually used.

 

Other BCC reconstruction pages

Reconstruction after BCC surgery – secondary intent healing

Reconstruction after BCC surgery – direct closure

Reconstruction afer BCC surgery – local flap

Reconstruction after BCC surgery – split skin graft (SSG)

Reconstruction after BCC surgery – forehead flap

Reconstruction after BCC surgery – pedicled nasolabial flap

 

Please click here to contact Mr Tehrani for a consultation on Mohs surgery or basal cell carcinoma

 

This information is for general knowledge only and does not replace information provided by healthcare professionals. If you have any concerns about any skin growth, or the treatment options, you should consult a medical professional urgently