Skin Graft Fell off 2 Weeks After Mohs Surgery

Always a good idea to discuss your situation with the surgeon who treated you. You may find that underneath the scab, there is fully epithelialized and vibrant skin.  Skin grafts can sometimes result in concavities, but these often fill in to some degree. Raffy Karamanoukian, Los Angeles

There is no real way to ascertain what has happened to the skin graft without an examination, and this should be done by your Surgeon sooner rather than later.  Skin grafts heal in phases, because they autogenous material without a blood supply.  Skin grafts (both full and split thickness) take weeks and usually months to look cosmetically acceptable.  For this reason, I very rarely use a skin graft on the nose unless there is a very specific reason to do so.  The initial and long term healing from a local flap (bilobe) yields a better color and texture match in the near and long term than the vast majority of skin grafts.  The biggest concern is the color of the graft, which very rarely matches the tone of nasal skin.

Skin grafts may form a scab on the surface and the deeper part of the graft may be living when the surface comes off. Some grafts lose the dead skin cell layer in sheets without it being a dead graft, but the dead cells that normally flake off every day, and can't be seen, can accumulate under the dressing and peel off after a graft without injury to the graft.  If the whole graft forms a hard scab, it's rare to fall out unless it is traumatically pulled. Cover the wound with a bandaid and call your doctor to be seen and determine how they want you to take care of the wound. Some of these wounds heal fine without additional surgery and sometimes a new graft is done several weeks later after healing allows the wound to fill in as much as possible.

The best answer to your question will be provided by your treating physician as he/she understands the specifics of your surgery and your overall medical condition. A full graft being lost at this stage of your healing process may signify a general healing impairment or a partial thickness tissue loss. Either of these conditions could require further medical intervention. Once again, I believe that it is prudent to keep your physician informed of your condition and if there are any significant changes (e.g. graft being lost).Be healthy and be well, James M. Ridgway, MD, FACS

As surgeons, we've all had skin grafts fail.  If its never happened to a surgeon, it just means they haven't done many.  That being said, I think we would all want to know if one of our grafts fails.  Sometimes the wound will still heal perfectly well and its not a big deal. Other times the wound is going to benefit from some kind of intervention.  Personally, I really want my Mohs patients to have a good result and I want to have the opportunity to intervene if its not healing according to plan. 

A good rule of thumb is if it's not healing as expected go back and see the doctor that performed the surgery. A graft falling off is not expected so go back and let the doctor examine the area to determine what if anything needs to be done.

The best advice is to call your surgeon.  Sometimes grafts may look poor - but actually still be viable.  Other times they can fail or even fall off.  Either way, your doctor will be able to help you determine what happened and the best course of action at this time.

I would most certainly speak with your surgeon about your concerns. Anytime you have a question about healing, an in person consultation is necessary.

Your story raises a couple of questions.  Many surgeons will tie a bolster dressing over a skin graft and leave for a week (or longer).  This becomes a bit soiled over the time and hard and can look like drying out skin.  Ocassionally a patient will lose this dressing and assume it's the graft.

Alternatively it is possible that the graft had an infection or poor blood supply and did have a partial or complete NON-Take , that is it didn't get enough blood to live.  This can lead to a depressed scar and may require revision.

Since there are a few possibilities, it is not possible to give a final answer.  This one would be best dealt with in person with your MD

It is very common for a Mohs surgeon to harvest a skin graft to correct the surgical defect created when removing a skin cancer. If the graft does not take, which can happen, I would recommend you show the area to your surgeon so he or she can advise you on local care to the area.