Failed skin graft following MOHs

Hi flowergarden

I'm really sorry to hear that your skin graft has failed. No wonder you feel devastated. Whilst not having been in that position myself I know that  has recently had a skin graft fail and is waiting to have the surgery repeated. I have tagged her in the hope that she'll reply directly to you and tell you of her experience. 

I have to say I'm surprised that you've been told that another skin graft won't be done. Was it the consultant who did your Mohs surgery who you saw today?

Keep us informed x

Hi Flowergarden,

I had two BCCs and two other lesions removed from the tip and sides of my nose in mid January. The two BCCs were too close together and too big to give any option other than a skin graft. Like you I was devastated 3 weeks later to find out that the skin graft did not take. The graft area was covered in what looked like a black scab.

The good news is that underneath the blackened dead skin of the graft my nose was healing itself and 10 days later the skin had fully grown over again. It was red and a bit bumpy at first but is improving every day. Now 2 months after the operation it looks just a little bit red now and slightly indented at the site but when I tell people I had surgery on my nose they are surprised.

Massage it gently a few times a day, keep it well moistured and use factor 50 suncream several times a day when you are outside and you'll give your poor nose the best chance of recovering well.

Let us know how it goes

Miranda

Thanks for replying to flowergarden Miranda2. It's good to know that the area can heal itself without surgical intervention!

x

HI latchbrook,

Thank you for your kind reply.  No, it was not the consultant who did my MOHS surgery, who said no to further skin grafts, but a different surgeon.  I have left a message for my surgeon to contact me today if possible.  I have read up a little bit about this self skin healing, it is called healing by "secondary intention".  The problem with it,is it works ok on concave areas but not on the tip of your nose, because as it heals it pulls and distorts surrounding tissues, and I can already feel a dip at the top of what was my graft.  Hopefully, my surgeon will be in touch and I can ask him to take a look at it.

He is a very good MOHS surgeon, but not a plastic surgeon.  I did see a plastic surgeon initially at another hospital, but when I asked about MOHS this surgeon transferred me to the other hospital as they could not carry out MOHS there.  I had an awful long wait to get surgery and in the mean time I could see my BCC growing.

It started with a little pearly white area on the tip of my nose about 6 or 7 years ago.  I showed this to several different GPs over this time, who all said it was nothing to worry about, and it wasn't until I developed a rodent ulcer, that would not heal that one of them finally sent me to see a surgeon in a dermatology department.  I feel badly let down by the medical profession, because if they had investigated this at the beginning, when the area was very small, I am sure my treatment would have been a lot simpler.  I have lost a lot of my trust in them at the moment, and wished I had pushed harder in the beginning for them to refer me for further investigation.

I think the problem is, that what ever procedure we are having, we all go into it feeling like soldiers going into battle, determined to beat this thing, and trying to be as brave as we can possibly be.  Then when things go wrong, we feel lost and hopeless.  Well, I certainly do.  But, I am grateful for your support and greatly admire all the people on this site who have been and, are still going through difficult times.

Flowergarden

Hi  

Sorry not to reply earlier but I've been out and about today. Hopefully your surgeon will have phoned you by now and you may have a different plan to just leaving it to heal on it's own.

I can quite understand you wanting your nose looking as good as possible, I'd be the same in your position. 

I know you feel you've been let down by the medical profession and that you wish you pushed harder to be referred but try not to be too hard on yourself. You don't know for sure that the operation would have been simpler so try not to dwell on that too much.

I hope you get the treatment you want and if you feel that you're not being listened to or the decision is wrong then you can always contact The Patient Advice and Liaison Service (PALS) at your hospital. Amongst other things they can help resolve problems when you're using the NHS.

Best wishes x

Hi Flowergarden,

So sorry to hear your graft has failed, I know how upset and frustrated you must be feeling. I also had a skin and cartilidge graft on my nose following MOHS which turned black. I was told it would fall off in 2-3 months, but actually it fell off over the weekend, which was 7 weeks post surgery. I was told that I should just let it fall off instead of having it removed as there may be a chance that something might have survived and it would be easier to regraft on a partial graft than to cut it off and start from scratch. I was told that if the regraft failed, then the next option would be a forehead skin flap. Now the black part has fallen off, it's clear that I will definitely need a regraft, however, there is actually a small part that does look like it has taken, but it's left a noticeable trough around the edges where the skin graft sloughed off as it was failing. The rim of my nostril still has a hole in it and is deformed, as is the skin between the 2 nostrils. There are 2 hard yellow lumps on the tip too. My surgeon said he took a risk doing my graft as the area was quite large and said that other surgeons would have opted straight for the skin flap. It didn't help that my aftercare was so poor. My grafts weren't checked, cleaned or redressed until 11 days post surgery. I'm hoping lessons have been learned and that this won't happen next time round. I could smell like a dead rodent smell as the grafts died. I found that rubbing Vick vapour rub just under my nose helped to mask the smell. 

If I had been in your situation where I was being told that they wouldn't do a regraft or skin flap repair, I'd be devastated too. It's such an obvious place to have any type of scar or deformity and I know mine has really affected my confidence. It may be worth going to your GP and asking for a 2nd opinion with a different consultant. Have they given a reason as to why it may have failed at all? Was it quite a large graft? Did they provide good aftercare for you?

Hi Miranda,

Thank you for your lovely reply.  It was so nice to hear from someone who has been through the same thing and you have given me hope that it may not be so bad after all.  At the moment I am massaging it with Vaseline to keep it moist but will take your advice about keeping it well moisurised and the sun cream.

I am due to see my own surgeon today, as the surgeon I saw the other day wasn't the one who carried out the operation and am waiting to hear what he has to say.   

I am so pleased to hear your nose is improving every day and thank you for taking the time to give me some encouragement.

I will let you how I get on

Flowergarden.

Hi Kezzajj,

Thank you for your reply.  It was so nice to hear from someone who had experienced the same shock and distress when their graft failed.  I am so sorry to read of all that you have been through, and are still going through.  My situation sounds very similar to yours and thank you for your advice.

I have been back to the hospital today and spoke to the surgeon who carried out the MOHS surgery.  He said that the problem with my graft was that it was bedded on cartilage, which was a bit like trying to lay turf on concrete.  He said he had had to go in deep to remove the cancer.  I now have to wait to see if any of the underlying graft will survive.  He wants me to go back to the hospital once a week, so that he can check on it's progress.  Then when it has finally come away, if there is any graft surviving I think he intends to let it heal and then attempt a second graft.  As you can see very similar to yourself.  He was very nice, much better than the other surgeon, I saw the other day who said they would do nothing, except let it heal by secondary intention, which would be fine if the end result was not too bad, but I am concerned that this would not happen in my case, as it is quite a large area and he had to make a deep incision.

I am sorry you had to wait 11 days for them to check your dressings, that must have been awful, and definitely should not have happened.  I know that by the time they removed mine after 7 days,  I couldn't wait to get them off.  They did not redress my graft, but just told me to apply Vaseline.  They told me it had taken, and in fact looked very good, and that is why it was such a shock when it went black and they told me it had failed.  Should they have redressed it, who knows?  Any way I am now hoping and praying that some graft survives so that he can attempt a second graft.  If not, like yourself, he is talking about doing a forehead flap.  He also, said that my nostril may pull up, as the graft contracts, all pretty scary stuff.

I know how you are feeling, so pleased that they managed to get the cancer out, but wondering when all this is going to end, and scared of what is to come.  Like everyone else on here, we just want to get our lives back on track.

I agree, it does affect your confidence, some people are good and give us a smile, others stare and it is how we feel about ourselves that is the most important of all.  But we are survivors, and it may be a long road, but we will get through this, and it is good to know that we are not alone.  Other people are going through the same experiences and understand and wish us nothing but the best.

Good luck, with your second graft, it sounds very hopeful as part of your graft has survived. Also, I hope that they can do something about the hole in your nostril or that over time it can repair itself.  Please let me know how you are getting on.

Flowergarden 

Hi Latchbrook,

Thank you for tagging Kezzajj, she replied to me and was a big help, as she is in a very similar situation.  

No it was not the surgeon who did my MOHS surgery I saw the other day.  I saw the surgeon who carried out my MOHS surgery today, and he was much more positive.  He said that maybe some of the underlying graft may have survived and if so he will attempt a second graft.  He explained that he had had to go down to cartilage to remove the cancer and so it was a bit like trying to lay turf on concrete, which I understood.  He said that we won't know how much has survived until the black top layer comes off, but he is going to see me once a week to check on it's progress.  We also discussed the possibility of having to do a forehead flap which is rather scary, but he said we will tackle this problem together, which I thought was lovely.  He is a very good communicator and made me feel involved in my treatment.  I can see he really cares and that gives me confidence.

Thank you for all your help and understanding Latchbrook, I will keep you informed on my progress.

Flowergardenx 

Hi  

That's excellent news! Yours Mohs surgeon seems to have explained everything well and it's good that he's going to keep an eye on it over the coming weeks. It does help enormously if you have confidence in your surgeon/consultant. They're not all good at explaining things to patients so I should hang on to him!

If you do have to have a forehead flap there are plenty of people on here who have had this procedure and can tell you about it.

All the best x