Caring for Your Skin Graft or Surgical Site After Mohs

Caring for your skin after Mohs surgery to remove cancer may feel daunting. You likely have many questions about what to expect during the healing process and how to nurture your skin graft or surgical site for optimal recovery.

At Dermatology and Skin Health, we understand your concerns and are dedicated to your successful postoperative care. In this detailed guide, we provide expert guidance on wound and graft care, managing discomfort, signs of complications to watch for, and what is normal over the weeks-long healing timeline.

What are the expectations following Mohs surgery?

The healing and recovery process after Mohs surgery takes time, usually several weeks to months depending on the size and location of your skin cancer and graft. Initially, it is common to experience some pain, swelling, bruising, drainage, and general discomfort in the affected area as the surgical trauma resolves.

You can expect the grafted skin to appear quite fragile, swollen, and pink or red in color during the first couple of weeks. A strict wound care routine will be required to allow your skin to heal properly and prevent infection. 

Work closely with your dermatologist to ensure you understand what is normal versus signs of potential complications. Prioritize care for your healing skin and be patient with the process.

What should you do in the immediate aftermath of Mohs surgery?

In the first 24-48 hours following surgery, be sure to follow your dermatologist's instructions precisely for caring for the wound and skin graft site. This usually involves:

• Keeping the area clean and dry
• Changing dressings at directed intervals. The University of Wisconsin Health suggests cleaning the wound once a day until the skin has healed or until the sutures are removed. They recommend washing the wound gently with soap and water, then rinsing and patting it dry.
• Taking prescribed antibiotics to prevent infection. According to a study by the National Center for Biotechnology Information, there is a recognized role for antibiotics in certain situations based on the patient's risk factors, surgical site, and most likely organism to cause infection.
• Managing pain and swelling with medication
• Avoiding activities that could dislodge the graft (e.g. if the graft is on the scalp, avoid nose blowing or activities that put pressure on the area)

For example, elevating your head and avoiding nose blowing would be important if your graft was on your scalp. 

How long does redness persist after Mohs surgery?

Based on our experience, some redness and inflammation around the edges of your skin graft site is normal and expected as the tissues heal. This inflammatory response may last several weeks or longer following surgery as your immune system works.

Some postoperative redness often resolves gradually after the first few weeks. The newly grafted skin itself will likely remain pink or slightly discolored compared to the surrounding skin for a couple of months after the procedure as it continues to establish blood flow and nerve connections. 

According to a study published by the National Center for Biotechnology Information, the phenomenon of postinflammatory hyperpigmentation can be observed as wounds darken as they are healing, and this can persist for some time after injury. With time, it usually blends.

Why is there a hard area around sutures after Mohs flap surgery?

According to our experience, the development of firm lumps or hard areas around the sutures and staple lines after Mohs flap surgery is caused by postoperative inflammation and fluid accumulation.

This is a normal part of the healing response. As the swelling diminishes over the first 2-4 weeks once the flap becomes more established, these firm areas typically resolve and soften up.

Notify your dermatologist promptly if the hard lumps persist beyond one month or if you notice any new ones, as that may indicate potential infection or other complications requiring examination. Otherwise, some hardness under staples or sutures isn’t abnormal.

How do you treat an open wound following Mohs surgery?

If Mohs surgery resulted in an open wound that could not be closed primarily with sutures or a skin graft, keeping the area clean and protected is imperative. Gently flush with sterile saline solution and change dressings regularly as directed by your doctor.

Apply antibiotic ointment inside the wound and ensure bandages provide adequate padding and protection while not sticking. Avoid hydrogen peroxide or alcohol, which can damage exposed tissue. Dermatology and Skin Health suggests carefully monitoring the wound for signs of improved granulation and epithelialization.

Report any worrisome odor, discoloration, or abnormal discharge to your doctor. With proper care, many open wounds can successfully heal by secondary intention. According to a study conducted in a UK teaching hospital, patients whose wounds were allowed to heal by secondary intention exhibited no complications.

How frequently should you change dressings after Mohs surgery?

Typically dressings need to be changed daily in the initial few days after Mohs surgery to monitor healing progress and remove any accumulated drainage or debris.

After about one week, dressing changes can usually be reduced to once every day or two unless moisture is collecting under the bandage. Any time the dressing becomes soaked through with blood or fluid drainage, it should be changed immediately to keep the environment clean.

Always wash your hands thoroughly with soap and water both before and after changing bandages around your surgical site to prevent infection.

How long should you keep bandages on after Mohs surgery?

How long bandages need to be worn depends greatly on the specific location. For example, skin grafts on the scalp usually require at least 7-14 days minimum of a pressure dressing to ensure proper healing and adherence. 

According to a study titled "Outcomes of split vs full-thickness skin grafts in scalp reconstruction in outpatient local anesthetic theatre," all patients had recorded good scalp wound healing, although healing via secondary intention may be the predominant healing mechanism due to the long follow-up timeframe without weekly surveillance.

Facial grafts, however, may only need dressings for the first 2-5 days before switching to just antibiotic ointment and a loose, non-stick bandage as tolerated. 

A study titled "Facial Reconstruction for Mohs Defect Repairs" suggests that patients should return at 7 days for suture removal, supporting the claim that facial grafts may only need short-term dressings.

In general, any grafted or sutured area should remain completely covered with a sterile dressing until the wound has fully re-epithelialized and sealed with no drainage. 

The study "Management of full-thickness skin grafts," reports that if a material is used to bolster the graft, it is typically removed 5 to 7 days postoperatively. After removal, patients are advised to keep the wound covered for an additional week and to avoid sun exposure for several months. 

What's the recommended wound care following Mohs surgery on the scalp?

Recovery after Mohs surgery on the scalp warrants special care given the location. Be sure to keep the head elevated, avoid hair styling products or accessories that put pressure on the area, and refrain from activities that compress or stretch the graft for at least 2 weeks.

Use any prescribed antibiotic or healing ointments as directed under the pressure dressing.

We suggest changing outer bandages regularly while keeping the scalp clean and appropriately moisturized.

Once the initial pressure bandage comes off, gentle scalp massage can help increase blood flow to establish the graft better.

What is the healing process like for a skin graft after skin cancer removal via Mohs surgery?

In the first week after a skin graft, swelling, bruising, and serous drainage are normal as the graft re-establishes blood flow and begins integrating with the surrounding tissues.

The grafted skin appears quite swollen, shiny, and pink or red during this time as new connections are forming with tiny blood vessels and nerves. Over the next 2-3 weeks, the graft shrinks and becomes paler and less raised as it incorporates more fully with the surrounding skin.

The healing process can produce itching, discomfort, and tightness around the graft. 

Based on a study conducted in Nigeria, donor site complications after split-thickness skin grafts included pain, itching, infection, dyschromia, hypo-pigmentation, hyper-pigmentation, and hypertrophic scars. 

After a few months, the edges blur and the color, texture, and thickness of the graft better match the surrounding skin, though some differences usually remain.

Should the skin graft from Mohs surgery develop a scab?

It is very common for a scab or eschar to form over the skin graft as it heals, which serves to protect the underlying fragile tissue. This temporary scab acts as a biological cover while new skin regenerates beneath the surface.

Try not to pick at or prematurely remove this protective scabbing. Allow the eschar to naturally detach once healed skin has formed underneath.

Are skin grafts painful in the aftermath of Mohs surgery?

Given the surgical trauma to the area, it is normal to experience some degree of mild to moderate pain or tenderness around the skin graft site during the recovery period after Mohs surgery.

The level of discomfort varies based on your individual pain tolerance and the graft size and location. Your doctor can prescribe appropriate pain medication to help manage postoperative pain.

As swelling diminishes and nerves regenerate, pain should steadily improve within the first week.

Why is it recommended not to exercise after Mohs surgery?

Dermatologists recommend avoiding strenuous exercise for approximately the first two weeks following Mohs surgery to allow your skin graft adequate time to properly heal and integrate with the surrounding tissues.

Early on, the graft is extremely fragile and vulnerable to being disrupted or damaged. Vigorous exercise increases blood pressure and circulation to the skin graft site which could impact the healing process. Start with only light, low-impact activity after the first week.

Avoid any sports, weightlifting, or exertion involving the scalp or grafted area for at least 1 month post-op, and discuss exercise restrictions with your doctor. According to another study by the NCBI, regular exercise may increase skin graft resistance and lead to prolonged graft survival in mice, but the effects on human graft survival are still unclear.

What is the typical post-operative care for scars after Mohs surgery?

After the initial post-operative period, regularly apply a topical silicone gel or sheet to help reduce the appearance of scars once fully healed. According to two studies, both silicone gel and sheets were effective at scar management.

Use daily broad-spectrum sunscreen and avoid UV exposure which can damage tender new skin. Based on our experience, gentle massage and keeping the area well-moisturized can help improve texture over time.

Does skin regenerate after Mohs surgery?

The skin does have an innate ability to regenerate itself following superficial injury by replacing damaged layers with new cells. However, this capacity for regeneration is limited when the deeper dermis and fat layers have been removed, as is often required in the removal of skin cancers like melanoma.

The incorporation of a skin graft brings in new skin cells to help fill the deficit created by the cancer removal. The surrounding skin also contributes to healing through epithelialization. However, according to reviews in the NCBI, while some animals can perfectly regenerate skin, wound healing in adult mammals like humans typically results in some degree of scarring.

For larger, deeper defects, complete regeneration of normal skin anatomy is unlikely. The grafted skin will provide coverage, but texture and contour irregularities may remain.

How do you address a hole left by Mohs surgery?

If Mohs surgery results in a hole or defect in the skin that is too large to close primarily, additional reconstruction is needed. Smaller holes may heal successfully by secondary intention with proper wound care. However, larger defects will require closure with a skin graft or flap technique.

Our Mohs surgeon will evaluate the size and depth of the resultant hole and determine the best method for filling that space. 

According to one study conducted by Washington University, patients undergoing nasal reconstruction after Mohs surgery share concerns about the appearance, invasiveness, and financial burden of reconstructive surgery. The study also found reconstructive options range from secondary intention healing to free tissue transfer.

Skin graft options include full-thickness (epidermis with dermis and fat), split-thickness (partial layers), or composite grafts using other tissues.

What precautions should be taken after Mohs surgery?

It is crucial to take care while recovering from Mohs surgery to support proper healing and prevent complications:

• Avoid blowing your nose forcefully or activities that put pressure on the graft
• Keep incisions clean and change dressings as directed
• Limit exercise and sun exposure until approved by the doctor
• U.S. Dermatology Partners emphasizes the importance of using sunscreen after Mohs surgery to prevent further skin damage
• Take antibiotics and pain medication only as prescribed
• Keep post-operative appointments for follow-up care
• Notify the doctor about signs of infection or lack of healing
• Protect scars and use silicone sheets once fully closed
• Apply daily sunscreen once healed to prevent skin damage

When can you resume normal activity after Mohs surgery?

Expect to need 1-2 weeks of rest and restricted activity after Mohs surgery. Grafted areas like the scalp require extra healing time. Activities like swimming should wait at least 1 month. Use caution and limit sun exposure to the affected area for 3-6 months. 

Listen to your body and ease back into your routine gradually under your doctor’s guidance. Don’t rush the healing process.

How should pain and discomfort be managed after Mohs surgery?

To manage postoperative pain and discomfort:

• Take prescribed pain medication as directed by your doctor. One study found the highest pain scores were associated with certain repair types, age, number of lesions, and narcotic use.
• Use cool compresses or ice packs on the affected area
• Keep skin grafted area elevated to minimize swelling
• Wear loose, comfortable clothing that avoids rubbing on incisions
• Apply topical numbing cream or anti-itch lotion if approved by your doctor
• Distract yourself with relaxation techniques like deep breathing or meditation
• Stay hydrated and eat a vitamin-rich diet to optimize healing

When to call the doctor after Mohs surgery?

Contact your dermatologist promptly if you experience:

• Severe pain not relieved by medication. A study found most patients had active pain on the evening of surgery.
• Excessive bleeding or fluid leakage from incisions
• Foul odor, pus, or purulent drainage from the wound site
• Warmth, swelling, or spreading redness around the graft
• Worsening itchiness or rash around incisions, as cited in the Nigeria study.
• Fever over 101°F which could indicate infection
• Lack of improvement or worsened appearance of wound or graft. Studies found these were potential complications.

We're Here to Guide You Through Healing After Mohs

We hope this guide has helped shed light on what to realistically expect following Mohs surgery and how to care for your skin during the healing process. 

While the recovery period does demand patience and diligent self-care, you should take comfort knowing that the vast majority of patients experience successful results and positive outcomes with skin cancer treatment using Mohs surgery. 

Don’t hesitate to utilize our dermatology practice as a trusted resource. At Dermatology and Skin Health, we are dedicated to ensuring optimal, personalized postoperative care every step of the way. Please reach out with any questions or concerns. Your skin health and wellbeing is our top priority.