In the anaesthetic bay of the operating theatre, a small plastic tube (called a cannula) will be placed into a vein in your arm or hand.
If you're having a general anaesthetic the cannula is used to administer intravenous sedation, which is the first stage of your anaesthetic.
If you’re having local anaesthetic, an injection will be given. This may sting briefly.
Once the anaesthetic has taken effect, you’ll be taken to the operating theatre.
There are numerous different techniques used to achieve each of the different types of skin flaps and grafts. However, usually the following principles will apply:
Both recipient and donor sites are carefully selected, prepared and marked. Sometimes the recipient site is made smaller with a special stitch called a purse string suture, to reduce the graft size.
Split skin grafts (SSG) are generally harvested with an instrument called a dermatome, which enables a precisely measured layer of skin to be removed. The graft is placed in sterile saline (salt) solution. Before application to the recipient site, it can be trimmed or meshed (placed over a graft meshing machine to increase surface size) as required.
It’s then sutured in place and covered with a dressing. The donor site is also covered with a dressing and heals without surgical intervention.
Full thickness skin grafts are harvested using a scalpel because the entire epidermis and dermis is removed. The graft is usually taken using a template and should exactly fit the recipient site, where it’s sutured in place. The donor site is then closed with sutures, or an SSG from elsewhere.
Local flaps are taken from the area adjacent to the recipient site and transferred whilst keeping the blood supply intact. The donor site may be closed with a suture or grafted with a SSG, depending on the nature of the wound.
Distant flaps require blood supply to remain intact from the donor site – the tissue is transferred from a different part of the body from the recipient site. The intact blood vessels are tunnelled under the skin to their new location. Sometimes this type of reconstruction requires more than one operation.
Free flaps require – in addition to removal and repositioning of skin, fat and/or muscle – removal and reconnection of at least one blood vessel. This is achieved by meticulous microsurgery. A common example of this type of flap would be a TRAM flap, using the abdominal muscle and fat to reconstruct breast tissue after mastectomy.