Authors: Liv Schöllhammer, MD, Christian Kaare Paaskesen, MD, Frederik Gulmark Hansen, med.stud. and Magnus Balslev Avnstorp, MD

A thorough physical examination is essential when evaluating the use of a local skin flap. The following key steps outline the most important considerations for patient assessment.

Patient Presentation and History

• Trauma mechanism: Identify whether the defect results from tumor excision or trauma.

• Radical tumor excision: Confirm that the tumor has been radically excised and verified by a pathologist before considering flap reconstruction.

• General patient condition: Assess for contraindications, such as uncontrolled diabetes mellitus, extensive smoking history, or bleeding disorders.

• Radical tumor excision: Confirm that the tumor has been radically excised and verified by a pathologist before considering flap reconstruction.

• Age and gender: Factor in how these may affect healing and flap viability.

• Medical treatment: Review the patient’s current medications, including blood thinners, antihypertensives, and diabetes management drugs. Plan for pausing or bridging therapy with low-molecular-weight heparin (e.g., Klexane or Fragmin) as necessary. Additionally, inquire about the use of herbal supplements, such as omega-3 fish oil, as these may have anticoagulant effects.

• Anesthesia suitability: Determine whether the patient is fit for general anesthesia. If not, consider local anesthesia as an alternative.

Physical Examination

• Skin quality: Assess elasticity, thickness, and general condition of the skin.

• Size and depth of the defect: Measure the defect precisely to guide flap design.

• Proximity to critical structures: Evaluate the distance to facial anatomic landmarks, such as eyelids, lips, or nerves.

• Donor site evaluation: Examine the quality and size of the donor site and assess its suitability for flap harvesting.

Pre-operative Information

Patients must be informed about potential risks, including:

• Complications: Infection, bleeding, pain, and scarring (including keloid formation).

• Functional issues: Risk of facial nerve damage, deformation (e.g., eyelid ectropion), or visible scarring.

• Flap failure: The possibility of vascular insufficiency leading to the need for revision surgery.

Post-Operative Care

• Larger flaps: Schedule follow-up appointments in an outpatient clinic approximately three months postoperatively.

• Uncomplicated cases: Routine follow-up with the patient’s general practitioner may suffice.

• High-risk cases: For melanomas or deeply infiltrating skin cancers near critical areas (e.g., eyes, nose, lips), close follow-up is essential.

Follow the link listed below for further details on the follow-up in the chapter malignant melanoma.