Wound Care

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Wounds are created in the skin when skin cancers are removed by Mohs surgery, an excision, or electrodesiccation and curettage (ED&C). Once the skin cancer is removed and the wound is created, there are several options to repair the wound.If feasible, the wound is extended by removing two triangles of normal skin and the wound edges are stitched together into a straight line. This is called a side-to-side closure or linear closure. Wound care for linear closures typically involves gently cleaning the area daily and applying petrolatum or Aquaphor and sometimes a dressing for 1-2 weeks.

Sometimes the wounds are too large for this type of linear closure and need to be treated differently. How we choose to close those wounds is determined by various factors including the wound size, location on the body, patient preference, the patient’s underlying health, and whether there is sufficient adjacent loose skin to stretch and rearrange into the wound. Sometimes the best choice is not to repair the area at all, but to let it heal naturally. This is called “second intention healing” or “healing by granulation”. Sometimes this choice will eventually result in a better cosmetic result than repairing the area by a flap or a graft (See “Skin Flap Repair” {this should have a hyperlink}). After your skin cancer is removed and the wound is created, your surgeon will discuss the various options available and you will decide together which option to choose. If we choose to allow the wound to heal by second intention, your surgeon and staff will explain how to take care of the wound. This usually involves cleaning the wound daily with soap and water (done easily in the shower) and then applying some ointment (petrolatum or Aquaphor) and a dressing.

This type of second intention wound healing usually takes 4 to 12 weeks to heal completely. How long it takes to heal varies based on any underlying medical conditions and the location of the wound. For example, diabetics usually take longer to heal. As another example, the further the wound is from the heart, the longer it takes to heal. Wounds on the face usually heal within 4-6 weeks, but wounds on the shins may take 12 weeks or longer. Sometimes, despite everyone’s best efforts, the wound needs a little extra help to heal properly. Our physicians are extremely knowledgeable in helping difficult wounds to heal. They employ various tricks including using special dressings and applying special medications that can be used on uncooperative wounds. If the wound does not heal as expected, we can always go back later and repair it using one of the other techniques at our disposal such as flaps or grafts.

Mild bleeding can also occur following any skin surgery. If bleeding should occur, apply direct, constant pressure without stopping for 20 minutes. If the area is still bleeding after two rounds of pressure, then call the office, even if it is after regular office hours. You will always be able to reach one of us. You can expect some mild discomfort after the anesthetic wears off. Usually plain acetaminophen (Tylenol) is sufficient to control the pain. Swelling and bruising are quite common after this type of surgery and should resolve in 2-3 weeks. Skin cancers can often involve the nerves of the skin and it may take as long as a year or two until normal sensation returns. It is possible that the area may stay numb permanently. Anytime a skin cancer is treated, no matter with what method, a scar results. Scars from second intention healing are usually red and hard in the beginning, but improve over time andbecome much lighter in color and softer. The maximum improvement may take as long as 1-2 years. Our physicians have many techniques to help improve the cosmetic result of the scar including steroid injections, dermabrasion, and lasers. These techniques are not usually offered before 2-3 months post-operatively.

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