Beyond the simple fusiform excision there are a variety of more complex surgical procedures which are indispensible to surgical management of skin lesions.
Local flaps utilise adjacent skin which is transferred to cover the surgical wound either by a process of advancement, rotation or transposition. Experience and confidence is required to undertake flap repair as the extent of the surgery is frequently considerably in excess of the size of the primary wound. The benefits, however, are a superior cosmetic and functional result with excellent tissue match.
Skin grafting is a basic technique which should be within the scope of all dermatologists. Donor skin is taken from a site where tissue is lax, and carefully sutured into place over the wound. The donor skin is usually full thickness, but fat must be removed from the undersurface of the graft. As a result, the donor skin may not be as thick as the surgical wound, resulting in a depressed final scar. The donor skin retains characteristics of its donor site, and care must be taken in choosing the donor site to match the skin around the wound bed.