Mohs micrographic surgery is a precise method for removing skin cancer layer by layer, aiming to preserve the maximum amount of healthy tissue. This technique results in a wound that requires meticulous post-operative care for proper healing. A correctly applied bandage is fundamental to minimize the risk of infection, encourage tissue repair, and lead to the best possible cosmetic outcome by reducing scarring.
Preparing the Wound and Necessary Supplies
Meticulous preparation of the surgical site and gathering the correct materials must precede any bandaging attempt. Begin by washing your hands thoroughly with soap and water to prevent introducing bacteria to the wound. The surgeon’s initial pressure dressing is typically left undisturbed for 24 to 48 hours. Subsequent dressing changes require gentle wound cleaning with mild soap and water or a saline solution.
To perform the dressing change, specific supplies are needed to maintain a moist healing environment. These include a non-stick dressing, which prevents new tissue from adhering to the material. You will also need paper tape or another medical adhesive, cotton-tipped applicators (Q-tips), and a non-prescription ointment like Vaseline or Aquaphor, or a prescribed antibiotic ointment. This moist environment facilitates faster healing and reduces scabbing, which can impede the final cosmetic result.
Specific Challenges of Nasal Bandaging
Bandaging a wound on the nose presents unique difficulties not encountered on flatter body surfaces. The nose is characterized by complex, three-dimensional curves, including concave sidewalls and convex tip and bridge. These contours make it challenging to achieve a secure, uniform seal with standard dressings.
The mobility of the nasal structure, particularly the lower cartilage portion, means that natural facial movements like smiling or talking can easily dislodge a poorly secured dressing. Furthermore, the nose possesses a rich vascular supply, making nasal wounds prone to post-operative oozing or minor bleeding. Therefore, the dressing must be firmly, yet gently, secured to manage drainage without causing constriction.
Step-by-Step Dressing Application
Once the wound is gently cleaned and patted dry, apply a generous layer of non-prescription ointment directly over the incision. Use a clean, cotton-tipped applicator to place the ointment, ensuring the entire wound and any visible sutures are completely covered in a thick layer, similar to the thickness of icing on a cake.
Next, customize the size of the non-stick dressing. Using clean scissors, cut the pad so that it completely covers the ointment and the full extent of the surgical defect, extending approximately one centimeter beyond the edges.
Carefully place the cut non-stick pad over the wound, avoiding touching the wound surface with your fingers. Secure the dressing using small strips of paper tape to conform to the nasal curves. Instead of one large piece of tape, which would buckle and lift, use several short strips applied in an overlapping, angular pattern, sometimes called a star or basket-weave application.
Begin by anchoring a strip of tape to a stationary part of the nose, such as the nasal bridge or cheek, and pull it tautly across the non-stick pad to adhere it securely to the opposite side. Continue to place these strips, overlapping and angling them to cover all edges of the pad. This technique allows the tape to mold around the convex and concave surfaces, ensuring the dressing is snug and fully sealed.
When to Change the Bandage and Monitor for Issues
The dressing change is typically performed once or twice daily, following the initial 24- to 48-hour period when the surgeon’s pressure dressing is left in place. When removing the old bandage, gently moisten the edges of the tape with water or saline solution if the adhesive is sticking to the skin. This helps prevent trauma to the surrounding area. The dressing should peel away easily, allowing for gentle cleaning before reapplying the ointment and a fresh non-stick pad.
Monitoring the wound site for signs of complication is a continuous part of post-operative care. While minor swelling and slight redness are expected, certain signs warrant immediate medical attention. These include excessive bleeding that soaks through the dressing and does not stop after 20 to 30 minutes of continuous, firm pressure. Signs indicative of a possible infection include increasing redness spreading away from the wound edges, worsening pain, warmth, a foul odor, or a fever above 100.4°F.