Editing Planning skin reconstruction (section)

== Key questions: ==

* Can it be closed primarily? Then do it.
* Is there enough local tissue laxity to allow a local flap? Then plan the best local flap.
* If no to both of the above, consider graft, healing by secondary intention or free flap.

=== Consider simplest option available (Gilles reconstructive ladder - if you can confidently perform a technique higher on the ladder that will lead to a better result, it should be offered to the patient) ===

#* Direct closure
#** If possible - do that
#** Otherwise continue below
#* Healing by secondary intention
#* Graft
#** FTSG
#** STSG
#* Local flap
#* Distant flap
#* Free flap

=== Consider aims of reconstruction ===

#* Aesthetic
#** Contour
#*** Difficult to disguise later
#*** Matching contour is therefore more important than colour
#*** Expect distorted anatomical features to improve slightly with time, once the underlying muscle relaxes, especially with young people
#*** Often a larger flap that uses an entire cosmetic unit or subunit of the face will give a better result than a smaller flap that crosses units
#** Colour
#*** Local flaps are a good match
#*** Grafts have an unpredictable final colour when the blood supply adjusts
#** Texture
#** Symmetry
#** Match features - hair
#* Functional
#** Sometimes harder to achieve than aesthetics
#** Depends on normal contour, but also sensation and movement
#** Scars inhibit function - position it in the place that least inhibits free motion

=== Consider aims of surgery ===

#* Functional vs aesthetic - match procedure and reconstruction to patient's desires
#* Be clear about level of aesthetic change aiming for - to look unremarkable, to not have a scar under makeup, or just not to attract attention in public
#* Don't chase after a goal the patient is not interested in, but at the same time don't believe a patient that says they don't care at all what it looks like

=== Consider anatomical factors ===

#* Where will the skin come from?
#** Is there an adjacent site with redundant skin? (check by pulling skin away from body)
#** If no, then use skin graft or distant flap
#** If yes, perform a local flap
#* How will it be transferred?

[[Category:Skin, soft tissue and wounds]]