Is this a normal appearance for 1 week after a Mohs graft on nose? (photos)

Question

I had a SCC removed a week and a half ago. The dermatologist did a delayed repair (5 days after the Mohs procedure). It is now 1 week after the graft and when getting the stitches out today the dermatologist wanted to keep the lower stitches on for another 5 days to make sure that the bottom part of the graft took. He thought it looked dark/shadowy. Is there a reason why the top portion would take faster than the bottom? Is there still a high likelihood that the entire graft will take?

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

Sachin S. Pawar, MD · Answer

Skin grafts go through an evolution of color changes during the first several weeks and months after surgery as the new blood vessels grow into and integrate within the graft. At 1 week, grafts can often have a similar appearance to what you show in your photos. There is always a chance that a portion of the skin graft may not survive, but in many cases even when this does happen, the final outcome ends up okay as the rest of the tissue heals in from the undersurface. I would recommend continuing follow-up with your surgeon in the first several weeks after the graft if you have ongoing concerns.

Richard J. Brown, MD · Answer

Yes it is pretty normal. I do a ton of these Mohs reconstructions. That skin graft will take months before it really looks the way it should look. It will go through lots of changes over the next 6 weeks. The early phase of wound healing is the inflammatory phase and that is why it looks so angry. It will slowly grow new blood supply and change over the next several months so just be patient. I know it is hard because it is your face, but rest assured it will get better. Sincerely,DrRickAZ

Joshua E. Lane, MD, MBA · Answer

Skin grafts are fragile repairs that simply take a bit more time to heal than other methods.  Overall yes I think the graft looks fine and the darkness that you are seeing is common and will most likely resolve.  Think of the graft like planting a piece of sod grass...it is harvested from somewhere and placed somewhere else.  In the process, the graft must recreate its root system and "take" to the new location.  There may be a few parts of the graft that struggle a bit more but overall I think it looks like it will be ok.  Be sure to follow your instructions, which likely call for keeping it greased up with Vaseline (or similar).

Is this a normal appearance for 1 week after a Mohs graft on nose? (photos)

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Is this a normal appearance for 1 week after a Mohs graft on nose? (photos)

Answers (4)

Answer: Skin graft question...

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