Reconstructive Skin Surgery
Plastic surgery is a fascinating specialty – it addresses clinical problems from head to toe and has been a wellspring of surgical creativity and innovations for centuries. Its fundamental principles – wise planning of reconstruction, creative thinking and delicate operating – represent a rock upon which a plastic surgeon’s mindset is set, a solid foundation upon which all other, additional subspecialist expertise is built on later.
Benign skin abnormalities are incredibly common; we all have them, scattered over our bodies. Most skin irregularities develop with time, are the consequence of skin aging hence, more skin lesions found in adults then kids.
Most patients that I see in my practice wish to be reassured of a benign nature of concerning lesion. In most cases, this is feasible by clinical examination only, but if classic, reliable features are not apparent, tissue biopsy may be required. The results of tissue sample analysis are normally available within 3-5 days of your surgery, in urgent cases after 24-48 hours.
A lot of people simply want to get rid of skin irregularities for cosmetic reasons or because lumps and bumps are unsightly or irritating by washes, clothing, shaving etc. Surgery leads to predictably lasting relieves, as long as scarring is favourable i.e. the scar after intervention is less noticeable then the original problem. Gallery below gives some indications as to what can be expected. Very fine surgical technique is of utmost importance, but is not the only predictor. Consultation is essential in order to assess pathology, skin type and quality and try to predict reliably if surgery can meet those expectations. Generally, moles and cysts enlarge with time whereas scarring produced by removing the lesions improves with time. Larger lesions require more extensive surgery to remove them, but general anaesthetic is very rarely required.
The commonest skin lumps and bumps seen in the clinics are moles, cysts, keratoses, warts and skin tags.
Moles are harmless skin growths that can appear at any time in your life. Some moles are “beauty spots”, but others may look unattractive and be a source of concern. Children and teenagers tend to develop flat brown moles. After the age of 20, we tend to acquire domed, clear or pink moles which can enlarge with age and/or become hairy with time. Moles are harmless, but can be unsightly, cosmetically unacceptable and be a nuisance, especially if repetitively caught on clothing, necklaces and combs, or cut during shaving. Moles occur when cells in the skin grow in a cluster instead of being spread throughout the skin. These cells are called melanocytes, and they make the pigment that gives skin its natural colour. Moles may darken after exposure to the sun, during the teenage years, and during pregnancy.
Cysts develop after blockage of the skin ducts. Skin sebum/sweat and daily skin debris collect under the superficial layers of the skin resulting in usually painless, firm swellings. They always enlarge slowly, but rate of growth is impossible to predict as it depends on individual rate of skin metabolism. They can become infected and require treatment with antibiotics, sometimes even a surgical input.
Keratoses are harmless thickenings of the superficial most layer of skin (epidermis). They present as flaky, scaly flat changes which can be itchy, but very rarely painful. Many people find them annoying as they get repetitively caught with underwear, clothing, jewellery etc.
Warts and Verrucas – are usually small, round, rough skin bumps caused by the human papilloma virus (HPV). Warts are common in children and hands and feet are most likely to be affected. Vast majority of warts and verrucas do not pose any symptoms or discomfort. It is usually their unsighty appearance and stubborn presence that drives people to seek help with removal. Successful treatment with creams, plasters and sprays is usually provided in the primary care. Lesions that continue to persist despite all non-surgical efforts, can be easily addressed, once and for all, by a simple operation.
In my practice, lesions are most commonly removed by formal excision (cutting of the lesion and the small area of nearby skin) and fine wound closure. Ocassionally, curretage (shaving) would suffice. As always, each one has its pros and cons which are decided on and explained upon clinical examination. Curettage wound does not require suturing and will heal on its own in approximately 2 weeks with regular change of dressings. It can however, leave a small patch of paler skin in the long term. Removal by excision, on the other hand requires suturing. Please refer to Gallery below.
Operation is performed under local anesthetic and usually takes between 20-30 minutes. It is carried out in the outpatients minor operating room so no formal hospital admission is required. Skin closure is done with the finest possible stitches in order to irritate tissue least and induce minimal scarring. I personally like to use one long stitch, hidden under the skin surface which is easily pulled out in 1-2 weeks. This method is technically trickier, but in experienced hands, it is a straightforward undertaking. Gallery below illustrates few clinical examples.
Wound is protected with a surgical tape and elegant, ‘shower proof’ dressing for 1-2 weeks. Such dressings will most likely stay in place until you are reviewed by the nurse in 7 days. We usually provide patients with spare dressings for exchange at home in case original ones become too messy. I usually review the wound and remove sutures if necessary at 2 weeks.
Patients must understand that removal of all lesions is done at an expense of a small scar. The aim is however, to produce a scar of a very good quality, which will eventually, be ever so faint i.e. less noticeable and conspicuous then original lesion. Fine suturing predictably leads to favourable scarring, but cannot entirely abolish some risks, like:
- postoperative infection
- delayed healing / wound breakdown (dehiscence)
- hypertrophic (lumpy) scarring
- numbness around the scar
Urgent concern after your surgery ?
Please ring the hospital where you have been operated on or my secretary and they will get in touch with me