Following a major skin graft, does your skin have memory of where it used to exist?

Question

My sister had a thumb size portion of skin/tissue/nerves removed from her forehead to graft to the side of her nose following the removal of a skin cancer. When her hubby cleans that area of her nose....she thought he was simutaneously cleaning her forehead and she wondered why he was doing that. He said he wasnt touching her forehead! Has anyone ever experienced this following a similar skin graft? She wont look at her nose yet to associate that skin to its new place. Will the sensation go away once she does?

I should add that a portion of skin was excised along with an attached strip of underlying tissue (kind of like the shape of a spoon) and flip-turned down to her nose. She's quite sober and not under any pain medications.

Answer 1

THANK YOU for describing the situation very clearly. What your sister had was not a skin graft at all, it was something called a "forehead flap", and I'll explain what it is, and how it differs from a skin graft. It's actually a very interesting topic!

There are several ways that we can cover or fill in tissue defects, such as what is left over after a cancer is removed, or a wound is created.

The simplest to understand is called "primary closure", where the edges of the wound are pulled together and sutures are placed to hold the tissue in that position until healing occurs. Next, you can easily imagine that if the tissue is too tight to pull closed with sutures, perhaps freeing a layer of skin and fat on each side might help mobilize it up enough to close. These are called "advancement flaps". A flap is a piece of living tissue which is moved from one site to another in order to repair a defect. There are several categories.

A "random flap" is just a piece of skin or tissue that is freed up around some of its edges, but remains attached enough that it continues to receive good blood flow. It is then rotated or stretched to fill in where an open wound defect will benefit. Random flaps are not designed based on any specific consideration of where arteries and veins are.

Next, there is something termed a "pedicle flap". A pedicle is an artery/vein pair (usually with a nerve) that supplies and drains a specifically located tissue or organ. A pedicle flap is a paddle of tissue which is specifically utilized to construct a wound closure or defect fill-in by mobilizing the tissue along with its normal artery and vein. The paddle of tissue is then moved to someplace else that the artery and vein can still reach to -with the tissue on the end.

Finally, for difficult jobs, there are "free flaps" where a piece of tissue, along with its artery and vein, is harvested and removed, only to be placed on a different part of the body where the artery and vein can be sewn back into other arteries and veins. For a brief time period, the flap is completely "free" of the body, and is then reattached.

The forehead flap that your sister had is a classic pedicle flap used for exactly the purpose that she had it used for. That is, nose coverage. This flap is based on the supraorbital vascular pedicle, a tiny artery branch that comes out along the brow from inside the eye socket. A spoon shaped piece of skin can be mobilized off the forehead, while it remains attached to its blood supply. It can then be rotated down onto the nose, in order to fill in a tissue defect, typically where a skin cancer is removed. The forehead flap will retain some sensation, because there is also a supraorbital nerve. The brain will, at least for a time, sense that the flap is still part of the forehead! I suspect also, that there are regions around the scar from the forehead flap harvest, that are numb, because the nerve was taken with the flap.

A skin graft is completely different. A skin graft is a shaving of skin alone which is lifted off of a donor site and then moved to another part of the body. There are full thickness skin grafts and split thickness skin grafts, but these do not require the preservation of an artery and vein. A skin graft is removed from one site and then placed on another. Once it is fixed in position, it needs to soak up oxygen and nutrients from the underlying tissue.

Skin grafts have no sensation at all, but a full thickness graft may transplant hair follicles from one site of the body to another (which is why I wouldn't use a hairy thigh donor site to get a graft that is to cover the forehead.

Answer 2

Well, I would have to say no. The medication answer is most likely, however it is possible it is just in her head and will go away on its own (and no, not speaking of any kind of psychosis).

When skin/tissue/nerves are removed and grafted to a new area of the body they are completely severed from the original nerves. It is possible to graft the skin to a new area of the body and reconnect the nerves - but the nerves will be connected to existing nerve bundles in the area creating sensation where you would expect - in her case, the nose.

At the same time, consider healing wounds and their itchiness. Bundle this with the close proximity of the skin (nose to forehead) and it is also likely that the rubbing motion on the nose merely pulled on the facial tissue and sensation was felt in the supersensitive new skin forming on the forhead.

Answer 3

your body will feel kind of crazy after a skin graft, or maybe if she was on pain meds after the surgery, they will make you think crazy things thats for sure. but no she shouldnt be feeling that at all, or maybe when he was cleaning the nose, she had her forehead on her mind, and she was just thinking about it... like i said med's can make you think some crazy things...

Answer 4

Looking at the nose will help, but not in any immediate fashion.

Answer 5

um, it shouldnt. maybe she should go to the doctor. but then again ive never had one done...