Wound Care After Mohs Surgery

Author: Huntsman Cancer Institute

Hello I'm Glen Bowen I'm a surgeon at Huntsman Cancer Institute and I'm going to talk today about taking care of wounds after having had skin surgery. So having done this for many years now I've notice that there's about five questions that patients ask routinely after they have had surgery. So I'm going to address each one of those five questions and try to explain what we'd like you to do in the post-operative period. So the first question is what do I do about pain? and the answer is the first thing you do is keep your heart rate a resting heart rate just like it is now while you are watching the video. Unless you have a heart rate that's high because you are afraid of the surgery but at any rate at just have a resting heart rate if you exercise or you bend over or your exerting yourself your blood pressure is going to go up and that can increase the pain so just have a resting heart rate the first night have surgery - it'll feel better.

The second thing I want you to do is use ice so you can use crushed Ice frozen peas, anything you like that's more soft but put it right over the dressing for 10 minutes every hour. So every hour on the hour, at 4 o'clock 5 o'clock 6 o'clock until you go to bed put the ice right over the wound for 10 minutes and that will get the wound it may ache a little bit but it won't be too bad but they will greatly reduce the swelling and it's the swelling that causes most the pain. The third thing we want you to do is to take the pain medication we give you so we'll select a pain medication that's appropriate for you and for the type of surgery that you have. When you get home from the surgery we want you to take your first pain medication with some food and then we want you to take another pill right when you go to bed with some food.It's much easier to stay ahead of pain than it is to catch up with it. It's a lot like a fly ball in baseball if you're in center field and when someone hits a pop fly it's much easier to run in on the pop fly than it is to try to back up on one so if you're in pain it's much harder to catch up with and get the pain under control then if you stay ahead of the pain so we do want you to take the pain medication even if you don't think you need it. The next question I get is do I change the dressing? And the answer is no. We want you to leave the dressing in place that we put on for two days.

The reason is is that this skin is a little bit like hot chocolate. When hot chocolate cools off it will form a skin over the top your skin will do the same thing and if it's covered for that period of time it will form a little film over the top of new cells that will make it watertight. So if you disturbed that it disturbs that new precious film that gets us we want it to be undisturbed for the first two days. After two days it's okay to take the dressing off and put on a fresh dressing and will explain how to do that at the time of your surgery. The next question that patients ask me is can I get wet? and the answer is no. For the same reason that the skin isn't watertight for 48 hours so you want to keep dry for 48 hours - two days. So you can take a shower you can bathe but you wanna keep the area dry Most of the skin surgery we do is on the face so you can take a shower the neck down.

If it happens to be on your arm you can take a trash bag and put it around your arm with an elastic band and you can take a shower and that'll keep the dressing dry. The same goes for your leg. You can put a trash bag around your leg.

Wound Care After Mohs Surgery

You have to be careful that you don't slip on that foot with the trash bag on. But you can keep it dry that way. If it's awkward you can always take a sponge bath. You can just use a wash cloth and bathe yourself with a washcloth and keep the dress dry. Now, if the dressing gets wet it's not the end of the world.

But I don't want wet dressing on there because it can trap bacteria so if you're dressing happens to get wet, just take it off put on a fresh dressing cuz I do what the dress in to be dry. The next question that I get is can I exercise and the answer is No. So again for the first two days we don't want you to exercise. The reason is as your heart rate goes up your blood pressure goes up. As a blood pressure goes up there's more swelling in the wound and there's a greater chance for bleeding so at least for the first two days we like it is just the mild activity around the house, we don't want you exerting yourself. After two days it's fine to exercise but we don't want to go back to a full workout routine.

We want you to ease into it so you might try brisk walking first if that doesn't induce pain then you can go to a jog if that doesn't induce pain you can probably ride your bicycle and and do other things. We don't you to do heavy lifting for the first week after you've had surgery but exercise would be fine to get your heart rate up. The last question that they have is what complications should you watch for and the answer is bleeding. So the main complications from surgery is bleeding now the type of surgery do were never around big vessels so none of you that I'm talking to are going to have a serious bleeding complication. But you can have minor bleeding complications which are messy but they're not dangerous.

So a minor bleeding complication means that the dressing that we put on your wound starts to get saturated with with blood so if your bandage is starting to turn red we want you to grab a handful of Kleenex put it right over the world with firm pressure for 10 minutes. After 10 minutes take off the kleenex and look for oozing, if it still is oozing get a fresh wod of kleenex do it again for 10 minutes if it's still oozing after that, you have to call us. So we'll give you 24 hour number, we always have a doctor on call 24 hours a day seven days a week 365 days a year. So you can always get a hold of us call the doctor on call, they'll tell you what to do. Now the second complication you can get is infection. Now infection doesn't happen in the first two days which is usually when bleeding happens.

It happens after the first two days and an infection is usually gonna include redness around the wound, swelling, warmth and sometimes oozing. So if you've changed your dressing at two days and the wound is very red and that's it's puffy you put the back if your fingers on it and if it feels warm or you notice oozing you need to call us. Wound infections are very easy to treat. But we need to know if you have one so it's really important to call us if you notice any of the signs of infection that when you take the dressing off at two days. So what are the signs: Red, it's warm, it's painful, or it's oozing. So if you see any those things just give us a call. What I like to do is show you the standard dressing that we put on most of our words after we've put in the sutures just so that you understand what it's gonna look like. So this is my secretary Kim whose been kind enough to a be the guinea pig here.

This is a wound caused by a red magic marker. So the first thing we do is we put on a little layer of antibiotic ointment. Just like this, right over the wound and that'll keep it nice and moist so that it doesn't dry out. We don't like the wounds to be totally dry and we just know from experience that we get a better cosmetic result if we keep lubricated with antibiotic ointment. The next thing we apply is a Telfa dressing and it's called telfa because it stands for teflon. If you can see the light reflect off the telfa dressing we use that because when it comes off it won't peel off the new delicate layers of cells that over the wound while it's healing. So we put on the teflon dressing and then we put on what's called the cigarette role So all we do is we take a roll of gauze and we roll it up into a tube and the purpose is when we put that over the wound and hold it down its going to apply gentle pressure on the wound and that will decrease the swelling and the risk of bleeding. The last thing we put on is a very soft dressing called mefix and the mefix is very nice because it's flexible and it will go right over the cigarette role and it conforms to the curve of the body surface and we just put mefix on like that and it will stay nicely in place for the first two days.

And we want you to keep that dressing on for two days unperturbed. So don't get it wet don't monkey with it, just leave it just like it is after two days we'll have you gently take off the dressing you can wash the wound with soap and water and then we'll have to do exactly what I did minus the cigarette roll. So you put on a little layer the antibiotic ointmen,t put on the non-stick dressing and then something to hold it on usually a band aid is just fine and we have you do that for one week. And that's all there is to it.


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