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The Importance of Skin Reconstruction

Posted by admin in Plastic Surgery

Skin is our largest organ in the human body. It guards the underlying system of muscles, bones, ligaments, and our internal organs. Skin is also our first line of defense again the environment and has many important functions that keep us living. Functions include protection again pathogens, excessive water loss, insulation, temperature regulation, sensation and the production of vitamin D. Skin may seem like a last thought, we see it every day, it’s what you see in the mirror, you moisturize it and protect it from the sun, but what else? Why else do we have skin? A major function that skin provides is the ability to transplant and grow skin for reconstructive uses. Our bodies cannot last long without the skin’s protection.  This post will dive deeper into skin reconstruction and the major uses for skin reconstruction. 

Types of Skin Reconstruction

Skin Reconstruction is the use of skin for reconstruction; this includes skin grafting and tissue expansion used for the purpose of reconstruction. These procedures are all available through plastic surgery and are usually covered by health insurance as they are for reconstructive purposes and not cosmetic. Those who seek skin reconstruction are those who suffer from breast cancer or skin cancer reconstruction, severe burn wounds, hand injuries, bedsores, and treatment of diabetic ulcers.

Skin grafts: Skin grafts are often used for burn patients, patients with extensive wounding, and extensive skin loss due to infections. The surgical removal of the damages skin is first required before the actual skin graft. The skin grafts serve two purposes for the patient, it reduces the course of treatment needed and it improves the function and appearance of the body which receives the skin graft. Skin grafts save thousands of lives every year but they are excruciatingly painful. While the pain of a severe burn is almost unimaginable so is the destruction it can cause. Large open wounds are highly susceptible to bacterial infections and if the body cannot regulate its temperature and hydration it will go into shock. This is why skin grafts are used and although very painful, they serve a greater purpose. There are two types of skin grafts: autografts and allografts. In all skin graft procedures, skin must be removed from site A then attached to the wounded area or site B. The most preferred source of skin for any skin grafting procedures is from the patient himself, this is called an autograft. The body’s immune system will ultimately try and reject foreign skin which is why sourcing from the patient himself is the best option for long-term treatment. In some cases, the patient may be too injured for the doctors to perform an autograft in which case doctors may place a temporary skin covering to slow down the chance of infection until the patient can regain strength for the autograft.  The second skin graft procedure is called an allograft, skin that is sourced from another human or a cadaver. Allografts can last seven to ten days before the body will ultimately reject them. A similar graft, Xenografts, are temporary skin covering from animals (usually pigs) that can only last three to five days before they are rejected. Allografts and xenografts are primarily used to buy time for the patient. In most cases, they can provide enough protection to allow the skin to regenerate on its own. When autografts are necessary, there are three major types to choose from. Deciding on which autograft method to use is dependent on the amount and depth of the skin loss on the patient. A Split-thickness graft is used for the shallowest wounds, those that affect only the epidermis and part of the dermis. It is called a split-thickness graft because the doctor removes only a few layers of skin from the donor site. Similar to split-thickness grafts, full-thickness grafts require all three skin layers, the epidermis, dermis and hypodermis, to be removed from the donor site. Full-thickness grafts are often used in cases where the cosmetic appearance of the injured area is very important. Full-thickness grafts differ from split thickness as they include hair follicles, sweat glands and blood vessels that allow the graft to look more natural. They also heal much more quickly than a split-thickness graft and is also less painful. The third skin graft method is called a composite graft; this is used for wounds that include bone, tendon, cartilage and the loss of muscle. For a nose reconstruction, for example, the surgeon would be required to harvest a graft that includes supportive cartilage tissue along with the skin layers.

Tissue Expansion: Tissue expansion is literally what it sounds like. Similar to a women’s skin during pregnancy, skin is stretched under the skin near the area of repair. This allows your body to “grow” extra skin for the use in reconstructive procedures.  Surgeons will accomplish this by inserting an instrument known as a “balloon expander” under the skin. Over time, the balloon will be gradually filled with a saline solution slowly causing the skin to stretch and grow. Once the skin has grown enough, it is then used to correct and reconstruct a damaged body part. Tissue expansion has many advantages as it has the most natural affect, skin color and texture are a perfect match for the area in which it is needed and little scarring results since there is no skin removal from one area to another. The major consequence of tissue expansion is the length of time needed to grow a sufficient amount of skin. This procedure can take as long as four months. While the balloon expander grows, so will the bulge under the skin, leaving undesirable affects for one going through scalp reconstruction but maybe desirable for those undergoing breast reconstruction.

Skin Cancer and Breast Cancer Reconstruction

There are many major problems that skin reconstruction can alleviate; the most used includes burn victims, breast cancer patients, and skin cancer patients. Skin grafts are commonly used for burn patients as we explained before, however, breast reconstruction and skin reconstruction after skin cancer are not as known. Similar to burn patients, skin cancer reconstruction uses skin grafts to protect a wound and promote healing. First your surgeon will perform an excision biopsy to diagnose and remove skin cancer under a local anesthetic. During an excision biopsy, your surgeon will remove the cancer and a border of healthy tissue around it, taking time to ensure the tissue does not contain any cancer cells.  Once this is done, a skin graft or skin flap is taken from the donor site, usually somewhere hidden by clothes such as the inner thigh, and applied to the wound. Skin flaps are taken closer to the wound and are partially connected to its original site allowing it to be continuously connected to your blood supple. This allows the wound to heal well once placed and looks more natural. This same process is used for breast reconstruction following a mastectomy immediately or delayed. There are a few types of breast reconstruction, the use of breast implants(similar to a breast augmentation), natural tissue flaps, or a combination of both. Skin grafts and tissue expansion are readily available for women in need of breast reconstructive surgery. Pain in both of these procedures will be very likely and your surgeon will recommend days and weeks of rest to strengthen your body for healing. Your surgeons will also tell you how to care for your surgical site, medications to apply or take orally, specific concerns to look for and when to follow up with your surgeon.

New advances in skin reconstruction are made every day because of their incredible value. From burns to infections to cancer, skin reconstruction saves thousands of lives. It is important to know our options and although these health concerns may seem cringingly horrible and painful, reconstructive procedures are available to save lives.

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