Forehead flap surgery - my experience

It's now 9 weeks since my Mohs surgery for a BCC on my nose, 8 weeks since my forehead flap surgery and 2 weeks since my flap separation surgery. I thought I'd share my experience in case anyone about to face the same surgery would find it helpful.

Forehead flap surgery

I had to get up very early as I had to be at the hospital for 7:15am and live about an hour and a half away from the hospital where I had my surgery. When I arrived I was asked some covid questions and was weighed and my height was measured. Then onto the reception area to check my personal details before being showed into a room on my own. As a woman under 55 I was asked for a routine urine sample to test for pregnancy. A nurse then took my blood pressure, temperature and respiratory rate. My ankles were measured for surgical stockings and plastic identity bracelets were put on my wrist and ankle. I was asked to change into a gown (I was able to keep my knickers on but had to take my bra off) and to put on my dressing gown and slippers. The anaesthetist came to see me to introduce himself and to ask a few questions and to see if I had any questions. The surgeon came to discuss the consent form and go through the risks. After that I was told to wait. Luckily I was the first patient on the surgery list so not too long a wait. A nurse then came to walk me to the operating theatre. When you go in you are shown into the anesthetic room. There were quite a few people in there including the anaesthetist I had met earlier. I was asked to take off my dressing gown and slippers and my glasses which were all put into a bag which was labelled with my details.

Then I was asked to get up on the bed for the anaesthetic. I was asked to explain in my own words what surgery I was expecting. Everyone was very chatty and friendly which helped with the nerves. The anaesthetist gave me a few breaths of oxygen and put in a cannula in the back of my hand. The nurse who took me to the operating theatre stroked my other hand which was comforting! The anaesthetist said that he was going to give me something that would make me feel a bit drunk and that I would go to sleep quickly after that. The last thing I remember is being asked if I was going to watch a new film that was coming out soon and the next thing I know I'm waking up in the recovery room! 

I don't know how long the surgery took but it must have been more than 2 hours. When I woke up I was aware that something was obstructing the vision of my right eye and that my lips felt very numb. The nurse told me that everything had gone well. I was given a sip of water and my blood pressure, oxygenation and respiratory rate was measured. I don't remember there being a lot of pain other than a headache. I was attached to a drip. I'm not sure how long I spent in the recovery area as I was quite drowsy!

I knew that I would be spending 2 nights in hospital so was then taken to a ward. When I got there my bags were there. A health care assistant introduced herself and took more observations and got me a drink of water. I had a straw as my lips were numb for quite a while. This was because of the local anaesthetic they inject around the nose. The nurse in charge introduced himself and encouraged me to drink water to raise my blood pressure after the surgery. I had my blood pressure, oxygenation, respiratory rate and temperature taken every hour for the next 4 hours and then as these were all OK then observations were done every 4 hours. 

After some time I asked if I could get up to go to the toilet. The health care assistants support you to walk to the loo the first time as you don't know if your muscles are still wobbly after the anaesthetic. Once they are happy you can walk by yourself you can go to the toilet on your own. I took the opportunity to look in the mirror at my face at that point. Weirdly I didn't see the flap at first! I was very aware of the stitches from the top to the bottom of my forehead and the dried blood on my nose. The flap itself was wrapped in a vaseline soaked gauze and obstructed about half way across my right eye.

One of the surgical team came to see me and said they had rung my family member to let them know that I was OK and that the surgery had gone well. She explained that they had been able to stitch all of the wound on my forehead. Some people may have part of the wound left open.

I didn't have that much pain and it was managed with paracetamol although stronger pain relief was available if I had needed it. I think the most painful part was my ear where they had to remove some of the cartilage to put in my nose. I had a headache from where the skin had been pulled tight across my forehead. There was quite a bit of blood oozing from the flap which ran down the side of my nose towards my mouth. I was given some sterile gauze that I could use to dab at the blood.

I'm sure if you've been to hospital before you know how difficult it is to sleep! This wasn't helped by the oozing from the flap which I was very aware of as I could feel it running down my face. It was quieter during the day so I napped then. The nurses and health care assistants were all lovely and the other patients on the ward were friendly and chatty so we had quite a good cameraderie.

Once I was able to go home I stayed with family for a week. I felt tired and a bit wobbly for a few days after the surgery. I had surprisingly little pain but this was managed with paracetamol. I got lovely black eyes after a few days which then healed up after about 2 weeks. I was given an appointment for a dressing change a week after the surgery and told to clean the stitches with cooled boiled water and vaseline. The dressing stayed on for the week and I used vaseline to keep the front of it moist. I was told not to touch the back of the flap. I couldn't get my face wet. It took several days to carefully clean away the dried blood from my nostril, ear and the stitched areas.

The first dressing change at the plastics outpatients clinic was a little uncomfortable as the back of the flap bleeds into the dressing. The nurse cleaned my face and the flap before putting a clean dressing on. The stitches were then covered with an antiseptic ointment. I was reassured that everything was healing well and there was no sign of infection. I was given a tube of ointment to take home and was told to use it on the stitches and on the dressing on the front of the flap. I had to go for dressing changes twice a week for 3 weeks and then as everything was healing so well I only needed to go once a week. The dressing changes got easier and quicker as the weeks went on. The oozing continued for probably about 3 weeks but had been easing off during that time. Half the stitches were taken out after 10 days and the other half after 2 weeks. That felt like a real milestone and things started to improve after that. The nurses made me laugh as they all kept raving about how beautiful my flap was! After 3 weeks I was told I could start massaging the large scar on my forehead which helps with healing. 

Unfortunately the flap separation surgery that was due after 4 weeks was cancelled due to staff sickness which had an impact on being able to cover the operating theatres. I was given a new date 2 weeks later. The delay was quite disappointing as I had the 4 weeks in my mind as a target but it couldn't be helped. So I had more appointments to change the dressing on the flap.

You aren't really prepared for the mental aspect of the surgery and recovery. I couldn't wear my glasses which made things quite difficult as my vision was impaired as I'm short sighted. I was told that I needed to keep my face warm to ensure a good blood supply to the flap so I wasn't able to leave the house other than for my hospital appointments as my surgery was in January. I live on my own so that was quite isolating and I got a bit of cabin fever not being able to get out for a walk. Family members did my grocery shopping and helped out with the heavier housework. One thing I did find helpful was that I had batch cooked quite a few meals which I put in the freezer. This helped when I didn't feel up to cooking from scratch. I found I had quite an increased appetite which I assume was the body's way of saying to eat well for healing! I slept on my back propped up with more pillows and this was quite uncomfortable until I got used to it. 

I was self conscious about my appearance and took the advice of other people on this forum who recommended taking a photo every day so that you can see the progress and how you are healing. It wasn't until I looked back at the early photos that I could see how much the flap had healed up. At the start the flap obstructed half of my right eye but after 4 weeks the flap only obstructed the corner of my eye. It is remarkable how quickly the body heals but you have to be patient and keep up with the cleaning routine. The nurses at the dressing clinic were supportive and took the time to ask how I was doing mentally as well as physically. I found it helpful to have the flap covered with the moist dressing the whole time and that the dressing changes were dealt with by the nurses. I was quite squeamish about the flap at first so I would have found it difficult to have to clean the flap and change the dressings myself. I've read other people's experiences of the surgery and lots of people had to clean and dress the flap themselves with occasional check ups so I think it depends on how different surgeons want the after care done. I was signed off work for the 6 weeks following the surgery. As I wasn't able to wear my glasses I wouldn't have been able to do my work even if I felt up to it as I use a laptop which I couldn't see properly. I wouldn't have wanted to go into work during this time as the flap does look odd to other people. I would think if you do a physical job you would want to be signed off as you wouldn't want to damage the flap or get your face dirty in case you got the flap infected.

I've waffled on enough now so I'll do a separate post another time about the flap separation surgery! I'm happy to answer any questions anyone might have about forehead flap surgery.