Mohs micrographic surgery is a precise technique for removing skin cancer, offering high cure rates while preserving healthy tissue. The ear is a common site for skin cancer removal due to sun exposure, and its intricate shape makes post-operative care particularly sensitive. Proper at-home bandaging is necessary to protect the surgical site from contaminants, maintain a moist healing environment, and ensure the best cosmetic outcome. Following specific steps for cleaning, applying ointment, and securing the dressing helps reduce the risk of infection and supports optimal tissue regeneration. This guide provides practical steps for managing the wound on the ear after Mohs surgery.
Necessary Supplies and Initial Wound Prep
Before starting the bandaging process, gather all necessary supplies to create a seamless experience. You will need non-stick gauze pads, often known by the brand name Telfa, which are designed to cover the wound without adhering to the healing tissue. Have a non-irritating tape ready, such as paper or surgical tape, for securing the dressing to the complex curves of the ear. Cotton-tipped applicators and a prescribed antibiotic ointment or plain petroleum jelly, such as Vaseline or Aquaphor, complete the dressing materials.
The initial preparation of the surgical site must occur before the new bandage is applied. Begin by gently removing the old dressing and carefully cleaning the wound with mild soap and water or a saline solution if directed by your surgeon. The goal is to gently remove any dried crust or drainage without causing trauma to the delicate healing tissue. After cleaning, pat the area completely dry with a clean gauze pad, ensuring no moisture remains.
The next step involves applying a barrier ointment directly to the surgical site. Using a clean cotton-tipped applicator, place a generous layer of petroleum jelly or the recommended antibiotic ointment over the entire incision and any sutures. This thick, continuous layer maintains a moist environment, which accelerates healing and prevents the formation of a scab. This application of ointment creates the foundation for the physical dressing to follow.
Step-by-Step Bandaging Technique for the Ear
The ear’s convoluted anatomy, featuring the concha, the helix, and the area behind the ear, requires a tailored bandaging approach. Start by cutting a piece of the non-stick gauze pad so that it covers the entire wound with a small margin of healthy skin around the edges. Position this non-stick dressing directly over the ointment-coated surgical site, ensuring it lies flat without bunching or wrinkling.
For wounds located on the outer rim of the ear, known as the helix, the dressing must be secured with narrow strips of surgical tape wrapped around the curvature of the ear. Apply the tape strips firmly enough to hold the dressing in place, but avoid excessive tension that could restrict blood flow or cause discomfort. Securing the dressing to this curved area often requires multiple overlapping strips of tape to conform to the shape.
When the wound is located in a concave area, such as the concha or the crease behind the ear, the dressing needs additional support. Small, clean cotton balls or pieces of fluffed gauze can be used to gently fill these recessed spaces. This technique provides a uniform surface, ensuring the non-stick pad maintains contact with the wound and that the overall dressing stays positioned. Finally, secure the entire dressing with longer pieces of paper tape, running the tape from the front of the ear, over the non-stick gauze, and adhering it securely to the skin behind the ear.
Dressing Change Schedule and Ongoing Maintenance
The typical schedule for dressing changes is once or twice daily, although this frequency may vary based on the surgeon’s specific instructions and the amount of wound drainage. The goal is to keep the wound continuously clean and moist, which is achieved by performing the cleaning and bandaging process at the same time each day. The initial dressing placed by the surgical team is often left undisturbed for the first 24 to 48 hours to act as a pressure bandage and minimize the risk of early bleeding.
Special attention must be paid to protecting the ear bandage during daily activities, particularly showering. It is necessary to protect the dressing from direct water exposure, which can be accomplished by covering the ear with a plastic cup or a plastic wrap secured with tape. If the dressing does become wet or soiled, it should be removed, the wound should be cleaned, and a fresh, dry bandage should be applied immediately to prevent contamination.
Maintaining the integrity of the dressing also involves avoiding activities that could displace or pull on the ear. Patients should refrain from sleeping directly on the operative side for several days to prevent pressure on the wound and sutures. Additionally, avoid wearing tight hats, helmets, or anything that creates friction or pressure against the ear until the wound is sufficiently healed. Strenuous activities and heavy lifting are restricted for at least the first week to prevent bleeding and swelling at the surgical site.
Recognizing Signs of Infection or Complication
Monitoring the surgical site is an important aspect of post-operative care, and it is helpful to distinguish between expected healing symptoms and potential complications. It is normal to observe some mild swelling, slight bruising, and a small amount of clear or pink-tinged drainage in the first few days after the procedure. Minor discomfort or soreness managed with over-the-counter pain relievers, such as acetaminophen, is a typical part of the healing process. Swelling and bruising peak around 24 to 48 hours post-surgery before gradually starting to subside.
However, certain warning signs indicate a need for immediate contact with the healthcare provider, as they may suggest an infection or other complication. Indicators of a possible infection include increasing redness and warmth that spreads outwards from the wound edges. Other concerning symptoms are the presence of thick, opaque yellow or green pus, a foul odor emanating from the dressing, or pain that worsens significantly and is not relieved by medication.
A fever, defined as 100.4°F or higher, or excessive, uncontrolled bleeding also requires prompt medical attention. Excessive bleeding is defined as saturation of the bandage after applying firm pressure for 20 minutes.