Skin Lesion Removal with Reconstruction

I, the undersigned patient, hereby grant my informed consent for the medical procedure of removing a skin lesion with reconstruction using a local flap or skin graft. I have been provided with detailed information regarding the procedure, its potential benefits, and associated risks. I understand that the procedure is not without potential complications or adverse outcomes, and I willingly accept these risks after careful consideration.

Procedure:

The procedure involves the removal of a skin lesion, followed by the reconstruction of the affected area using either a local flap or a skin graft. The specific technique will be determined based on the size, location, and nature of the lesion. The procedure will be performed under local anesthesia.

Benefits:

1. Removal of Lesion: The primary benefit of this procedure is the complete removal of the skin lesion, reducing the risk of potential complications or further progression.

2. Improved Aesthetic Appearance: Reconstruction with a local flap or skin graft aims to restore the natural appearance of the treated area, minimizing visible scarring and promoting improved cosmetic outcomes.

3. Restoration of Function: In certain cases, the reconstruction can help restore functionality by covering exposed underlying structures or improving mobility in the affected area.

Risks and Complications:

1. Bleeding: There is a risk of bleeding during or after the procedure, which may require additional interventions to control or resolve.

2. Infection: Despite adherence to strict sterile techniques, there is a risk of developing an infection at the surgical site. This may necessitate further treatment, including antibiotic therapy or additional procedures.

3. Poor Wound Healing: The reconstructed area may experience delayed or impaired wound healing, leading to wound breakdown, wound dehiscence, or poor cosmetic outcomes.

4. Scarring: While efforts will be made to minimize scarring, it is important to note that all surgical procedures carry the risk of visible scars.

5. Skin Graft or Flap Failure: In rare cases, the skin graft or flap may not survive completely, resulting in partial or complete loss. This may require additional surgical interventions for further reconstruction.

6. Numbness or Sensory Changes: Following the procedure, the treated area may experience temporary or permanent numbness, altered sensation, or changes in skin texture.

7. Further surgical excision or treatment: Sometimes additional treatment such as wider excision, creams or radiotherapy may be required for certain lesions.

I have had an opportunity to ask questions and have received satisfactory answers regarding the procedure, its benefits, risks, and potential complications. I understand that there may be unforeseen risks or circumstances that could arise during the procedure. I acknowledge that no guarantees have been made regarding the results or outcomes of the procedure.

I hereby voluntarily consent to undergo the procedure of removing a skin lesion with reconstruction using a local flap or skin graft. I have read and understood the information provided, and I authorise the doctor and their designated medical staff to perform the procedure.

Patient's Signature: ________________________

Date: ________________________

Doctor's Signature: ________________________

Date: ________________________

**Please retain a copy of this consent form for your records.**