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Reconstructive procedures may be indicated after tumor removal to reconstruct skin deficits, depending on the anatomical location and extent of surgical resection. Reconstructive procedures may include local or pedicle skin flaps, delayed primary closure or secondary closure, free skin grafting or free microvascular cutaneous, and muscle or myocutaneous grafts. Detailed descriptions of these reconstructive procedures are beyond the scope of this chapter, and the reader is referred to several texts that describe these procedures in detail (Pavletic 2003, 2018; Swaim 2003; Kirpensteijn et al. 2013).

The surgeon should plan the reconstructive procedure before the definitive tumor excision by marking the margins of tumor excision and the proposed flap site with a marking pen prior to surgery (Figures 4.3a–e).

Consideration should also be given to the degree of resection required in a circumstance. For example, a grade I MCT located on an extremity could be treated appropriately with a more conservative 1 cm lateral margin resection. An ulcerated grade III MCT with regional lymph node metastasis may be treated with a palliative marginal resection, and a grade II MCT on the pelvic region may require wide excision and an axial pattern flap reconstructive procedure.

If a reconstructive procedure is used, the donor site and recipient tumor resection site should be treated as two separate surgical fields, with separate gloves and instruments used for each site to decrease the risk of contaminating the donor site with tumor cells. The donor site should be completely closed before moving to the recipient tumor resection site.

Reconstructive flapping procedures can be used successfully in combination with radiation therapy. The severity of complications was reduced when flapping procedures were used as part of the planned therapy as opposed to those used to correct a complication or failure of radiation therapy (Séguin et al. 2005).

Open wound management is an acceptable option after skin tumor resection. Wound healing time is prolonged compared to reconstructive procedures (Prpich et al. 2014).