Wound Not Healing After MOHS Surgery on Top of Head

Thank you for your question. This sounds like a typical wound healing after surgery with second intention healing, and no closure at the time of surgery. On the scalp, though it may take anywhere from 4-6 weeks and possibly longer, this often leads to an excellent cosmetic result and the wound fills itself in "from the bottom up". This is a slower way of healing, but with a deep and somewhat larger lesion sometimes this is the best way to heal versus creating a very large tissue flap closure for repair. Typically these wounds require frequent cleaning with soap and water, and sometimes necessitate antibiotics. Many wounds healing in this fashion however, heal well with simple cleaning, and do not need antibiotics. If there is any concern regarding the lesion, I suggest that you see your surgeon for evaluation of the wound, and certainly if there is still drainage from the wound. This may be normal, or could be a sign of infection. I hope this helps.

Discuss it with your surgeon. Things should be healing by now.  Things that make it not heal well are smoking, prior surgery/radiation, residual lesion, etc.  You can also see a facial plastic or oculofacial plastic sugeon.

It is not uncommon after surgery to have a slow healing wound but appropriate wound care can prevent further complications. I suggest you discuss with your surgeon or a wound care center.

First off, I am sure you have an overwhelming amount of stress around this surgery. I would take a deep breathe and relax. I am not sure of the details of this surgery but it sounds like this area was allowed to heal by second intention (on its own) following surgery. This is sometimes used instead of stitching, especially in an area like the scalp where there is not a lot of slack skin to pull together. When a wound heals this way, it takes a long time, around 2 months like the other two Mohs and Reconstructive surgeons said. The way you are describing it, makes it sound like it is healing normally but I would agree with the other two surgeons and recommend you contact the Mohs surgeon to see if he/she can take a look at the area. The wound care that you are doing is a good regimen and one does not need to use an antibiotic unless there is an infection. Although it is scary, often times it is ok to wash the area with soap and water, which is what I recommend to my patients. Check with you Mohs surgeon again to see what their preference is. Good luck.

It's not unusual for a wound to take 4-6 weeks to heal after surgery if allowed to heal by seconday intention (in other words, to let it heal by itself without repair). As a general rule, you want to keep the wound moist and covered to facilitate good healing. I would recommend that you contact your Mohs surgeon and go in to his/her office and be evaluated. Whenever my patients have a question about whether things are healing correctly, I encourage them to come in so that I can examine the wound and discuss with the patient. Good luck.

It sounds like the wound was allowed to heal by secondary intention which is quite commonly done and a perfectly reasonable approach on the scalp where the skin is tight. Wounds that are allowed to heal by themselves can take awhile to heal- longer than a month.  HAving said that, despite your proper wound care regimen, now is a good time to see your mohs sugeon for wound care follow up.  I tend to follow up with patients whom I allow to heal secondarily two to 4 weeks after the procedure.

It is not uncommon for a Mohs Defect of the scalp to take 2 months to heal.  Keep the area clean, shower and wash daily, and apply an ointment such as povidone iodine twice daily.  This will help expedite the healing process.  Be sure to follow your surgeons instructions.

 I assume that the wound was left open to heal. That size wound should take about 2 months to heal. Slight oozing is to be expected. I typically have my patients use plain Vaseline or a prescription topical antibiotic ointment until wounds clear but you should contact the Mohs surgeon for further instructions.