Facial reconstructive surgery
When a cancer is removed from a body or a reconstructive procedure is performed the function of the body part and its appearance is affected. Surgical intervention is invariably required when the cancer of the eyes is removed. The loss of eyelid volume leaves a lesion on the face whenever a tumor is removed. The procedure of tumor resection today is aimed at not only complete removal of the tumor but is also aimed at keeping the scarring to its lowest and to preserve maximum of natural skin.
All large sized tumors call for a reconstructive facial surgery while the smaller benign tumors may completely heal on their own, which is known as granulation. Skin flaps or skin grafts are used for reconstruction of the face. Both the procedures involve borrowing of the skin from the patient’s body parts only. Once the tumor is removed the flap is placed on the site which then covers the face completely or partially. The flap is a skin tissue which is made by an incision which then covers the targeted portion of the face.
If the size of the lesion does not permit a skin flap a skin graft may be done. In this process, the lesion is covered with a piece of skin that is taken from some other body part. Skin grafts can be divided in two types; spilt thickness grafts which involve only the topmost layer of the skin or full thickness grafts where not only the skin is taken but the blood supply structures and underlying muscles are also used. Although the skin grafts are fairly successful and do not require further treatment, in some cases the grafting may need to be repeated. Split thickness skin grafts are made up of some part of the dermis and the epidermis. The thickness of the graft depends upon the patient’s requirement and the donor site from which the graft is to be taken. Split thickness grafts have two main benefits. Firstly, they can be used to cover larger areas and the chances of the body rejecting the graft are almost zero. Also, because the thickness of the graft is not that much, the donor site can again be used after six to seven weeks.
Full thickness grafts include both the layers of the epidermis as well as the dermis. Since large thickness of skin is harvested, the donor site is sutured and the site is then grafted with a split skin graft.
In case the wound is big or the site of the tumor excision cannot be sutured because of lack of skin allowance, skin grafting is done. The skin grafting can be done immediately after the excision of tumor.
The term donor site with respect to skin grafting procedure refers to the part of the patient’s body from which the skin graft is taken. Therefore, the graft site implies the body part where the grafting is done.
The split skin graft may be taken from the thighs, upper arms and buttocks. Once the graft is taken, the donor site is left with a graze which heals within a month or two. Because of the greater thickness of the full thickness grafts once the graft is taken the site needs stitching which is done by pulling the edges of the skin together. The full thickness grafts are harvested under local anesthesia and can be taken from the abdomen, inside of the thighs and the upper arm.
The stitches form the scar in a straight line. The skin grafts are generally stitched securely at the graft site so that they do not move. To be accepted by the body and to survive at the site of grafting the grafts may need around a week or two.
Some precautions have to be followed closely after the grafting. Grafts are very delicate and fragile therefore the patient should be very gentle and take complete rest from all activities. The grafted area should not be rubbed vigorously. The patient may feel pain after the grafting once the anesthesia wears off. Mild swelling accompanied with bruising is completely normal which subsides on its own.
In some cases the body may reject the graft and graft failure may occur. It can be due to improper stitching of the graft which may lead to shearing movement of the graft. Infection at the graft site, bleeding and accumulation of fluid beneath the graft may also cause the rejection of the skin graft.
Once the dressing of the split skin graft is removed a large patch of skin with redness will be visible. In most cases the color of the grafted patch is not the same as the surrounding skin and may be either lighter or darker in comparison.
Apart from skin graft facial reconstructive surgery also includes:
Scar revision surgeries: Scars on the face can be caused because of accidents or other injuries. Scars can cause disfigurements on the face. Scar revision surgeries done by the experts helps in hiding the scars. W plasty and Z plasty are two commonly used techniques that are used in scar revision surgeries.
Facial paralysis surgery: Facial reconstruction surgery is also done to correct the deformities caused by paralysis of the face. The surgery helps restore the symmetry For example small weight might be placed in the upper eyelids to prevent the eyes from getting dry.
Facial trauma reconstruction: Traumatic facial fractures need expert reconstruction surgeries that include realignment of bones and repair of the nerve damage underneath.
Facial reconstruction surgery is done with expert care only to ensure maximum repair and functionality of various features.