Skin & Soft Tissue Reconstruction

Some wounds will not close on their own. A pressure sore over the heel or the hip, a diabetic ulcer on the sole, an open wound over exposed bone or tendon, or a defect left after clearing dead tissue has no surface from which skin can grow across. Bringing in healthy, well-supplied tissue from beside it is what closes it.

Your surgeon chooses the simplest cover that will hold. A local flap rotates skin and its underlying tissue from next door. A muscle flap brings in bulk and blood supply to fill a deep cavity and fight infection. A skin graft covers a shallow wound with a healthy base.

The wound has to be ready first. That means dead tissue removed, infection treated, blood supply to the limb checked and corrected where it is poor, pressure taken off the area, and blood sugar under control. Closing a wound over an untreated infection or a limb with poor circulation fails, so the preparation is part of the operation and not a delay to it.

You are asleep under a general anaesthetic, or the lower half is numbed with a spinal for a foot or leg wound. The operation takes one to three hours.

Your surgeon starts by cutting back the wound edges and base to bleeding, healthy tissue, and sends a sample of deep tissue for culture. The flap is then marked, raised on its blood supply, moved across and stitched in without tension. A drain is usually left under it, and the place the flap came from is closed directly or grafted.

You wake with the flap covered by a dressing that leaves a window to look at it, and the limb elevated or offloaded on a special mattress or boot. Nurses check the colour of the flap regularly through the first day.

Three to seven nights in hospital. The most important instruction is offloading: no weight at all through a foot flap for four to six weeks, and no sitting or lying on a flap over the buttock or hip for a similar period. A wheelchair, crutches or a total-contact cast is arranged before you go home.

Drains come out in the first week and stitches at two to three weeks, later than usual, because these wounds heal slowly. Dressings continue at a clinic until the suture line is fully sealed. Walking is reintroduced gradually in protective footwear from six weeks under supervision.

A healed flap is not the end of it. Diabetic ulcers recur in around 40 percent of people within a year, so your diabetes control, custom footwear, daily foot checks and regular chiropody keep the wound from coming back.