Skin Cancer Reconstruction Before & After Photos

Skin Cancer Reconstruction Before & After Case 1

This gentleman had melanoma of his scalp excised, leaving an open wound of the scalp. To close his wound with a smooth contour — and without leaving a bald spot — rotation flaps were performed. A little bit of crusting around the incision will clear up now that staples are out, and he is returning to full activities one month after his surgery.

Skin Cancer Reconstruction Before & After Case 2

This man had melanoma of his scalp with wide local excision performed.

Reconstruction was performed with opposing rotation flaps, respecting the hair line and the blood flow to the scalp.

A few things I keep in mind for the reconstruction:
– I try to capture at least two primary blood vessels in each flap (from the supraorbital/supratrochlear, superficial temporal, postauricular, and occipital arteries),
– I plan to release widely but incrementally as needed,
– I will use subgaleal scoring as needed to help relieve tension,
– and I pay attention during the initial resection and the dissection to look for sources of blood flow to the margin of the wound.

Repair is performed with PDS suture in the galea for longer term support, and staples in the scalp maximize blood flow are well-tolerated.

He is seen at 4 months, with some redness from further topical treatments as directed by his dermatologist.

Skin Cancer Reconstruction Before & After Case 3

Skin cancer reconstruction is highly rewarding, with each and every person and wound posing its own challenge.

Here, a skin cancer involving the ala of the nose required full thickness excision, including the skin, cartilage, and nasal lining on the inside of the nostril.

A single-stage nasolabial flap provided the skin and nasal lining, and ear cartilage was used to provide structure and support.

Another option would be a two-stage forehead flap, where skin and muscle is taken from the forehead and rotated down. However, that requires 3-4 weeks with a bridge of skin from the forehead to the nose, and second surgery to divide and inset the flap. Sometimes, a third stage is even performed to improve the shaping and symmetry.

Results are seen here on the table results and at just 1 month, with the scars maturing nicely.

Skin Cancer Reconstruction Before & After Case 4

Scalp reconstruction ranges from a simple, straight repair, all the way up through a free flap reconstruction with skin grafting.

Here, a pinwheel design and release of areas of adhesion allowed the scalp to rotate and advance in to cover the exposed bone.

This was done as an outpatient going home the same day, without needing to take muscle or skin from another area of his body.

It also gave robust coverage that’s more durable than a skin substitute graft, and could be done in one stage instead of two or more.

He is seen here at 2 months healing up wonderfully.