Wound Care After Mohs Surgery Repair?

Question

I have read pros and cons regarding the proper care for a granulating wound on the upper forehead. A forehead flap procedure covered the large defect resulting from removal of a melanoma from the right side of my nose, 4 weeks ago. The surgeon left a circular wound at the top of the flap that is to granulate in. He told me that I could use a Tefla pad to cover the wound. How many hours covered? How many hours uncovered? How many days/weeks? Using what to clean wound? Topical on wound?

Hooman Khorasani, MD · Answer

Thanks for your post.  I hope you are healing well after Mohs reconstruction.  After every Mohs procedure you should be provided with written and verbal instructions about wound care so you should have crystal clear directions on how to care for the wound.  Please contact your surgeon as they may have forgotten to provide you with these instructions.  Every surgery is different and every surgeon has their own wound care preferences.  I hope this helps.

Richard J. Brown, MD · Answer

These wounds are very simple and straight forward to the surgeon but I do see how confusing it can be to the patient. When you are left with a wound to fill in on it's own we call it a healing by secondary intention. The first thing to keep in mind is a dry wound is a dead wound and it will not heal well. I spent one year during my residency training doing research on wound healing and scar management and one thing that was consistent was a clean moist wound heals the best. They way to take care of this wound is to keep it clean with soap and water. Then place antibiotic ointment over a telfa pad, generous amounts, and place it over the wound. Tape this in place. You should change it 3-4 times a day. Wash off the old ointment before applying the new ointment every time. This is very important. The wound will slowly close over time and depending on how big the wound is it can take 4-8 weeks. The wound will contract closed and when it has completely healed you are done. Hope this helps!!

Andrew Kaufman, MD · Answer

Every surgeon has a slightly different strategy as to proper wound care so you should check with your doctor as well.

	As a general rule, wounds heal better and faster when they are kept clean, moist (with a bland ointment) and covered with a non-stick bandage. Wounds that are not kept moist and covered or wounds that are allowed to dry out or scab up will heal more slowly.

	Talk to your doctor to confirm exactly how they would like you to care for your wound. Good luck.

Adam J. Mamelak, MD · Answer

After undergoing a surgical procedure, proper wound care is essential to ensure the best healing and cosmetic outcome. Your surgeon should supply you with instruction precisely how to care for your wound. These instruction may differ from one doctor to another, from the type of procedure you had (ex. forehead flap vs. skin graft), from the type of skin condition you had treated (ex. melanoma vs. ulcer) and from the location. Before you ask a second opinion, it is crucial you discuss how to care for your wound with your doctor.

	 

	In general, wounds heal better if they are kept moist and kept covered. I advise my patients to keep ointment such as Vaseline or Aquaphor on their wounds and cover them with bandages such as Telfa. I discourage my patients from "airing out" their wounds. Wounds exposed to the air actually heal slower than wounds kept covered.

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