Mohs surgery: vertex incision dissolvable stitches still oozing, what should I do? (Photos)

Question

Hi my dad had mohs surgery done (vertex incision) 2 months ago. Large area on scalp 2nd course of antibiotics still oozing. He has to go for radiotherapy and we just don't know how to get it to heal. I have used salt and water. ..dressings have been aqua flex silver alternating with manuka honey antibacterial dressings. Doc has now prescribed steroid cream. Any advice please

Raffy Karamanoukian, MD, FACS · Answer

Moh’s surgery on the face often requires surgical repair and reconstruction to reapproximate the skin edges. Flaps or direct closure techniques are used. It is important that you optimize scar healing during this phase in order to reduce longterm scars. For red scars, we use Vbeam laser, followed by fractional laser for scar topography and contour. We recommend Plato’s Scar Serum twice daily for the immediate postoperative period. Fractional laser is safe for scar laser therapy. 
There are treatments for swelling and edema of the scars. If there is residual sutures or edema, we advise you to follow a scar treatment protocol that can minimize the time to recovery. Our office specializes in scar revisions for Moh’s surgery. 
Best, 
Dr. Karamanoukian
Realself100 Surgeon

Sarah Schram, MD · Answer

Given that he has been treated for an infection and it is has not improved I would consider a diagnosis of erosive Pustular Dermatosis (EPD).  EPD is an inflammatory condition that can occur after significant trauma (such as from surgery) to the scalp.  It is typically treated with very strong topical steroids and should improve.  I would recommend follow up with a Mohs surgeon or board certified dermatologist.

John Louis Ratz, MD · Answer

Skin of the scalp can be very tight and closure of a large defect may be very difficult. Without having more information, it appears that this was a large defect that was closed primarily. This can result in so much tension on the wound that the tissue begins to necrose(die). Such necrotic tissue can heal over time with proper wound care. I suggest having a culture done to see if an oral antibiotic is needed. If so, this should be done. Wound care does not have to be complicated by all the "stuff" you're applying. First of all, the necrotic tissue should be debrided under local anesthesia by your doctor. Wound care should then consist of cleaning the wound of any clear yellow or milky yellow liquid exudate that develops with sterile normal saline on gauze pads or cotton-tipped applicators. These should be used to firmly rub away any debris or yellow liquid. Once cleaned, petroleum jelly(Vaseline) should be used to cover the wound, followed by a non-adherent dressing such as Telfa followed by gauze pads to soak up any discharge or oozing. this should then be secured with tape or a wrap dressing such as Coban(also available and less expensive as Vet-Wrap). The wound care should be done twice daily initially. Proper healing is taking place when islands of granulation tissue can be seen. Granulation tissue is rich in blood vessels and resembles the flesh of watermelon. Granulation tissue will eventually fill the wound and drainage is then decreased allowing wound care to be decreased to once a day. Wound cleaning should be gentle at this point. Once granulation tissue fills the wound to the level of normal skin, new epithelium(first layer of skin) will form from the outside in. New epithelium is quite fragile and wound cleaning should be limited to gently touching the healing portions of the wound and no rubbing with the gauze pads or cotton-tipped applicators.If I am correct about what is going on, radiation therapy should not be started until the wound is completely healed which, for this wound, could take six or more weeks. Radiation treatment at the point the wound is currently at could not just delay healing, but stop it all together. You might also want to get a second opinion from another Mohs surgeon.

Gabriel J. Martinez-Diaz, MD, FAAD · Answer

Hello - please seek the evaluation of your Mohs Dermatologic Surgeon and consider the diagnosis of Erosive Pustular Dermatosis of the Scalp.

Mohs surgery: vertex incision dissolvable stitches still oozing, what should I do? (Photos)

Answers (4)

Answer: Consider the diagnosis of erosive pustular dermatosis of the scalp

Answer: Consider the diagnosis of erosive pustular dermatosis of the scalp

Recommended reading

Everything you need to know about Mohs Surgery

Our mission is to create a world where every investment in modern beauty is Worth It.

Mohs surgery: vertex incision dissolvable stitches still oozing, what should I do? (Photos)

Answers (4)

Answer: Consider the diagnosis of erosive pustular dermatosis of the scalp

Answer: Consider the diagnosis of erosive pustular dermatosis of the scalp

Browse related questions

Recommended reading

Everything you need to know about Mohs Surgery

Our mission is to create a world where every investment in modern beauty is Worth It.