Caring For Skin Flaps And Grafts
You will need to care for the flap or graft site as well as the donor site. When you come home after surgery, you will have a dressing on your wounds. The dressing does several things, including:
- Protect your wound from germs and reduce the risk of infection
- Protect the area as it heals
- Soak up any fluids that leak from your wound
To care for the graft or flap site:
To care for the donor site:
- Leave the dressing in place. Keep it clean and dry.
- Your doctor will remove the dressing in about 4 to 7 days, or give you instructions for how to remove it.
- After the dressing is removed, you may be able to leave the wound uncovered. However, if it is in an area that is covered by clothing, you will want to cover the site to protect it. Ask your doctor what type of dressing to use.
- Do not apply any lotions or creams to the wound unless your doctor tells you to. As the area heals, it may itch and scabs may form. Do not pick scabs or scratch the wound as it heals.
The Mohs Surgery Procedure
A surgeon removes visually cancerous cells first, then carefully removes very thin layers of skin, one at a time. Each layer is examined to detect any sign of cancer.
The person undergoing surgery is usually awake and alert, and the surgical site is numbed by anesthesia.
Most procedures take place in a doctors office or clinic. The wound is bandaged after each layer of skin is removed while the surgeon examines the skin under a microscope. The procedure continues until no signs of skin cancer are present.
How Is Skin Cancer Treated
Skin cancer can be treated in several ways depending on the type of cancer in question and its stage of development.
Some common treatment options include:
- Radiation therapy
Once you have been diagnosed with skin cancer, your dermatologist or surgeon will explain your options and advise you on the best steps to take.
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How Can I Reduce The Chances Of Developing Skin Cancer
The best way to reduce the chances of developing skin cancer is awareness and proper sun protection.
Ensure that you always put sunscreen on and dont sit or lay in the sun for long periods especially during peak hours. Its also best to avoid visiting tanning salons, which can damage your skin and may cause skin cancer in the long run.
People with moles should consider making a mole map. That way, they can keep an eye on their moles and watch for any unusual changes in shape, size, or color.
For more information about how to identify a melanoma, read our blog here.
Why Should I Have My Post
Our plastic surgeons are highly skilled and experienced in a wide variety of reconstructive techniques, allowing them to successfully treat the wide spectrum of wounds that can result from Mohs excision of skin cancer. Moreover, our plastic surgery office will work closely with your dermatologists office to coordinate the timing of the reconstruction with that of the skin cancer removal. We also understand that dealing with the skin cancer diagnosis and its related treatment can be emotionally difficult for patients, and our caring surgeons and staff will support you throughout the entire process.
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What Are The Types Of Skin Graft Surgery
The types of skin graft surgery are:
- Split-thickness skin graft : During this procedure, your provider removes the top layer of skin and only part of the second layer . Providers usually use STSG to cover large areas of damaged or missing skin. They typically take healthy skin from the thigh, bottom, belly or back. The area where the skin was removed from normally heals on its own over 1-2 weeks.
- Full-thickness skin graft : During an FTSG, your provider removes and transplants the top layer and the entire second layer of skin. FTSG procedures require more healing time than STSG because the transplanted skin is thicker. Providers may choose FTSG for a part of the body that you dont usually cover up with clothing, such as the face. For FTSG, providers often remove healthy skin from the groin, arm or collarbone area and then close the donor wound right away.
- Composite graft: During this procedure, providers transplant skin as well as cartilage or other soft tissues. Composite grafts can repair damage to the nose, fingertips and ears.
Skin Graft Healing And Aftercare
After the surgery, your doctor will give you skin graft aftercare instructions for the graft site and donor site. Unless your doctor says otherwise, you should keep the skin graft dry and try to avoid sunlight on the skin graft area. Youll likely need to avoid activities that could stretch the graft site for up to four weeks.
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How Do I Care For The Skin Graft Once It Has Healed
Skin grafts have fewer oil and sweat glands so tend to become dry. When the graft is completely healed, it should be kept clean by gentle washing. Avoid very hot water and never use highly perfumed soaps, creams or bubble baths until it is well healed. You need to gently massage oily cream in once or twice a day to moisturise the graft and keep the skin supple. E45, aqueous cream or unperfumed Nivea can be used. This is usually kept up for 6 months.
Hyperbaric Oxygen Therapy For Skin Graft Healing
Hyperbaric oxygen therapy can significantly increase the likelihood of graft survival and enhance skin graft outcomes.
Regular HBOT sessions effectively treat compromised skin grafts and flaps by restoring and strengthening the natural body processes needed to ensure skin-grafting success. HBOT also helps to increase the viability of any compromised tissue, reducing the need for additional grafting procedures.
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Nasal Reconstruction After Mohs Surgery: What To Expect
A common reason for nasal reconstruction is Mohs surgery to remove skin cancer on the tip of the nose. The facial plastic surgeon will discuss surgical options with you to reconstruct your nose, including a local flap, a skin graft or a staged procedure such as a forehead flap.
Local flap: This reconstructive procedure uses the available skin on the nose to close the incision. You may be a candidate for a local flap if the wound on your nose is small and can be covered by stretching the skin. Our surgeons recommend this procedure a few days after Mohs surgery to allow the skin to begin healing and improve the outcome of the procedure.
Skin graft: If the area of missing tissue is too large to be covered with a local flap, the surgeon may relocate skin from elsewhere on the body. During your consultation, the surgeon will identify the best source for a skin graft. As with a local flap, reconstructive surgery takes place a few days after Mohs surgery. A skin graft is performed in one stage as an outpatient procedure.
Staged procedure: A staged procedure such as a forehead flap is a multi-stage process that can begin the day of the Mohs procedure. The surgeon places an expander under the forehead to stretch the skin and create more healthy skin to be used for the nose. When enough new skin has grown, the surgeon will use it to cover the nose and create as natural a result as possible.
When To Call The Healthcare Provider
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Fever of 100.4°F or higher
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Pain that gets worse or doesnt go away
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Bleeding of the graft that cant be stopped by applying pressure
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Signs of infection, including increasing swelling or redness of the graft, white or bad-smelling discharge from the graft, red streaks from the graft site, or pus at the wound site
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Edges of the graft site that start to open up
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Any other signs or symptoms indicated by your healthcare provider
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Physiology Of A Skin Graft
A skin graft is unique from other forms of nasal reconstruction, in that it does not have its own blood supply. Instead, a skin graft must recruit blood supply from the surrounding tissues at the recipient site. There are several stages involved in this process.6
The first stage of graft revascularization, plasmatic imbibition, begins with the deposition of fibrin and granulation tissue to the underlying tissues. The graft absorbs nutrients during this stage, adding significant water weight that helps maintain vascular patency and keeps the graft moist.6,7,8 After this stage, the graft is firmly secured to the underlying recipient site. After 48 hours, inosculation occurs as graft vessels and recipient vessels form connections through angiogenesis and the anastomosis of existing vessels.9,10,11 Although complete return of sensation over the grafted area is never fully achieved, partial sensation usually returns after several months.
The bridging phenomenon allows a skin graft to be used to cover a relatively avascular surface. As long as a portion of the defect is well vascularized, a skin graft can recruit vessels from this area to supply blood vessels to the graft overlying the avascular recipient site.10
Skin Grafts For Skin Cancer
Surgery for skin cancer involves removing the affected area and some of the surrounding, healthy-looking skin. If the area is fairly small, it will be possible to close the wound by bringing the edges of the skin together. Larger wounds may need a skin graft to cover the area.
Skin grafts are layers of skin taken from another part of the body and placed over the area where the cancer has been removed. A partial thickness skin graft is where the epidermis and a part of the dermis layer is used. The skin is usually taken from the thigh, buttock or upper arm. Skin will grow back in this area.
A full thickness skin graft is where the epidermis and the full dermis layers are used. In this case, only a small area is taken from the donor site and the skin edges of the donor site are then stitched together to heal. Skin may be taken from the neck, the area behind the ears and the inner side of the upper arm.
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Are You Interested In Learning About Mohs Surgery
If you are interested in learning more about skin cancer or Mohs Surgery in the Los Angeles or Orange County area, contact Dr. Hung by calling our Pasadena office at , our Newport Beach office at , or by filling out our online contact form.
The Office of Dr. Vincent Hung
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Mohs surgery treats skin cancer by gently removing the affected area and a thin tissue rim that surrounds the tumor.
Even though this treatment preserves as much healthy tissue as possible and requires less reconstruction than other types of skin cancer treatment, the affected area will still need to be reconstructed, and a scar will form.
What Should I Expect After Skin Grafting
- Medicines may be given to prevent or treat pain, severe itching, or an infection.
- Bandages will cover the surgery area to hold the graft in place. Do not remove the bandage yourself. Your healthcare provider will arrange for the bandage to be removed or changed after a few days. Keep the bandage clean and dry.
- You may need to avoid certain activities , such as exercise or lifting heavy objects. You may also need to avoid activities that can irritate your wounds. Your surgeon will tell you which activities to avoid or limit.
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Know That Surgery Sites Heal In Time
Had basal cell on the side of my nose going toward the corner of my eye. Couldn’t see anything on the skin, but thanks to the keen eye of my derm she saw it, and did a biopsy, and sent me to a Mohs specialist at UAB. He removed it along with surrounding tissue, sutured, sent me on my way looking, well, terrible! Within 1 year, the scare is completely gone & can’t tell anything was done. Thankful for those yearly scans. – Debbie
I had Mohs done on a very small spot on side of nose right by eye. They had to put me to sleep and did a flap on forehead. Also had Mohs on lip. It went about 2 inches outside of mouth and about an inch in mouth. Great results. Almost unnoticeable. – Joy
How Is The Area Reconstructed
Skin grafts are used to fill in regions that have been affected by skin cancer, whether the growth was on the face, ears, arms, back, or legs.
This type of graft will depend on the area of skin cancer and how much skin needs to be removed to ensure that all of the cancer cells are eliminated.
Skin grafts are either full-thickness or split-thickness. While both techniques move the skin from a donor area , they require a different amount of material.
A full-thickness graft removes a full layer of epidermis and dermis from the donor region.
A split-thickness graft takes a complete layer of the epidermis but only a partial thickness of the dermis.
These donor samples are then meshed and applied to the open wound.
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Once Your Mohs Surgery Wound Heals
Scars tend to improve over the course of several months, with significant improvement noted during the first month. In some cases, scar revision or resurfacing of the scar may be of benefit after Mohs surgery.
If you are doing well at the time of suture removal, we may discharge you to the care of your referring dermatologist.
It is important that you keep regular follow-up examinations with your dermatologist. You are at increased risk of developing additional skin cancer and pre-cancers. Early diagnosis and treatment will benefit you. Examination of your surgical site is also needed to monitor for any recurrence of your treated skin cancer.
General Wound Care After Mohs Surgery
How to Replace a Pressure Dressing Following Mohs Surgery
What to Do for Bleeding After Mohs Surgery
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When Can I Go Back To My Usual Activities After A Skin Graft
Recovery time after skin graft surgery depends on your overall health, the size and type of skin graft and the location of the graft site. Your provider may recommend waiting several weeks before exercising, driving or lifting anything heavy. Ask your provider when you can get back to the activities you enjoy.
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Recommendations For After Mohs Surgery
You can expect minimal discomfort after Mohs surgery pain can usually be managed well with acetaminophen . Significant discomfort should be reported to us.
You may experience some localized swelling and bruising, which may not be at its worst until three to four days after surgery. Some swelling and bruising is normal and should improve within a week.
If you have surgery on your forehead or nose, you may experience some swelling of your eyelids, which, at times, may nearly close them due to swelling and bruising settling in that area. Similarly, swelling and bruising may occur down the neck, and rarely the chest, when surgery is performed on the chin or jawline area. To help reduce swelling and bruising, apply an ice pack for 20 minutes each hour while awake for the first 48 hours following Mohs surgery.
While bleeding rarely occurs after Mohs surgery, a little blood or seepage on the dressing is normal. If you notice active bleeding , remove the bandage and apply firm pressure over the area with dry gauze or a dry cloth for 20 minutes.
If bleeding continues, contact our office or the on-call dermatologist . On rare occasions, it may be necessary to have the bleeding stopped by cauterization.
We recommend you limit vigorous physical activity, excessive bending over or exercise for seven days after your Mohs surgery to allow your wound to heal and prevent bleeding or damage to your stitches.
What Is The Most Common Skin Cancer Removal Method
Luckily, weve come a long way in successfully removing skin cancer from patients bodies.
Mohs surgery is the most common and successful procedure for removing skin cancer while doing as little harm to your body and aesthetics as possible.
With Mohs surgery, the cancer area is removed, one cancer tissue layer at a time. Each tissue layer is examined in a lab until no cancer cells remain. This process is repeated, layer after layer, until you are free from any cancer.
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Facial Skin Cancer Reconstruction
Skin cancer is the most common type of cancer affecting humans and is most commonly caused by cumulative sun exposure throughout a persons lifetime. Skin that is exposed to sunlight is the most susceptible to skin cancer formation, making the face one of the most likely sites for skin cancer to develop. The three main types of skin cancer include basal cell carcinoma, squamous cell carcinoma, and melanoma. The severity of these cancers can range from very small, superficial lesions that can be cured with topical or cryotherapy to large, invasive tumors that can spread throughout the body and require extensive surgical resection and potentially even radiation or chemotherapy. For this reason, all suspicious skin lesions or areas of ulceration that do not heal should be taken seriously and evaluated promptly.
Mohs Skin Graft On My Nose Appears To Be Healing With A Significant Indentation/depression
I had a full thickness skin graft measuring just over 1 cm wide on my nose one month ago after basal cell carcinoma removal. At first the graft appeared level with the surrounding skin but now I’m noticing a significant concaveness in the graft site. The graft starts at the centerline of my nose and then down the right side. Is it likely to improve or level out any with time? If not, is there anything that can be done to lessen the indentation?
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