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Wide excision of skin lesions and skin grafting

General

For wide excisions, additional tissue around the scar where a tumor has previously been removed, is excised. Wide surgical margins around the removed tumor may reduce the risk of relapse. In cases where a lot of skin has to be removed and it is difficult to close the wound primarily, it may be necessary to use a skin graft or flap reconstruction to cover the defect.

If the area to be covered is large, the risk for relapse is considered to be high or the patient's condition does not allow an operation with comprehensive flap reconstruction, and the condition of the patient permits it, the defect will usually be covered with a skin graft.

For a skin graft, the skin tissue is moved from one part of the body to another without preserving the tissue's blood supply. New blood vessels grow from the recipient area in a few days after the operation.

Skin grafts may be full-thickness or split-thickness: 

  • A full-thickness skin graft is used for small defects where the cosmetic and functional requirements are higher. This especially applies after excision of skin changes and skin tumors in the head/neck region. Full-thickness grafts consist of both the dermis and the epidermis.
  • Split-thickness graft is often used for larger defects, and in cases where cosmetic considerations are not possible or needed. Split-thickness grafts consist of the epidermis and parts of the dermis.

Indications

Wide excision is carried out for:

  •  Tumors in the skin where a wider margin is needed to reduce the risk of relapse 
  •  Cases in which all tumor tissue was not removed during the first operation 

Goal

  • Cure the disease
  • Reduce the risk for recurrence

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