16 Days Post MOHS Surgery/reconstruction - to Cover or Not to Cover?

A skin graft from behind my ear was used after MOHS surgery to remove BCC - The oculop. surgeon who did the reconstruction has told me to keep Vaseline on it but not cover it. MOHS surgeon today told me to keep it covered with a band aid and lots of Vaseline. What should I do? Does it look normal for 16 days?Also, a portion of the graft at the top has detached and is "dented in" which the doctor told me to keep Vaseline on and let it heal by secondary intention..will it heal dented in?

Doctor Answers (4)

Wound Healing and Whether to Cover or Not Cover a Wound

+2

As a general rule, if a wound is not completely healed, keeping it covered with an antibiotic or bland ointment (e.g. Vaseline, Aquaphor, Polysporin) is a good idea. The wound produces various factors in the fluid of the wound that stimulate wound healing. Allowing the wound to dry out or "scab up" removes these factors and the wound heals more slowly and with greater difficulty. As a general rule, I have patients keep the wound moist with an antibiotic salve and cover it with a non-stick bandage (e.g. Telfa) to keep the antibiotic salve intact and protect the wound from sun exposure. As the oculoplastic surgeon was responsible for reconstructing your wound following Mohs surgery, I would follow up with that doctor. If you need a second opinion, you can talk to the Mohs surgeon or contact another oculoplastic or plastic surgeon. Good luck.


Los Angeles Dermatologic Surgeon
4.5 out of 5 stars 6 reviews

Mohs

+1

Dont get lost in the details. I suggest soap and water twice a day and a thin layer of an antibacterial ointment after washing

Ryan Neinstein, MD, FRCSC
New York Plastic Surgeon
5.0 out of 5 stars 36 reviews

16 days post skin graft

+1

Each situation is unique and only your surgeon knows the specific details of your procedure and should be the person commenting on post-operative questions such as this

Sam Naficy, MD
Seattle Facial Plastic Surgeon
5.0 out of 5 stars 138 reviews

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Healing after excision (Mohs surgery)

+1

Skin grafts require a complete blood supply to "take" and live.  Sometimes for a variety of reasons there is some compromise of the blood supply and the grafts don't completely take.  It is not necessarily an all or nothing phenomenon and the graft may be partially taken.  In many cases, the wound is allowed to heal  and then decisions about whether any further touchups or surgery may be helpful can be made.  Revisions down the road can involve further surgery sometimes or more simpler interventions like laser or dermabrasion.  It is quite common for a wound (either post surgery or allowed to heal on its own) to look depressed, off color and improve dramatically with time.

It is not possible to tell completely if there is partial take of your graft from the photo, though that is certainly possible. Skin grafts can have a variety of appearances in the immediate week or two after surgery.  Many, including me, do believe that "moist" wound healing, e.g. with Vaseline helps speed healing.

 

The final decision on when and whether to intervene and possibly revise the scar is ultimately based on how its healing and the input of both the surgeon and the patient.  I'd recommend following up with the reconstructive surgeon (the oculoplastic surgeon) for his/her input. 

Daniel Berg, MD
Seattle Dermatologic Surgeon

These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.