Mohs surgery is a precise technique for removing skin cancer, often used for basal cell and squamous cell carcinoma. When performed on the ear, post-operative care presents unique challenges due to the ear’s complex, curved structure and lack of bony support. Proper bandaging is necessary to support the surgical site, prevent infection, and encourage optimal healing. Careful bandaging aims to maintain a moist environment, which minimizes scab formation and promotes faster skin regeneration.
Gathering Necessary Supplies
Successful wound care requires having the correct materials to manage the delicate surgical site. The primary dressing material should be a sterile, non-stick gauze pad, such as Telfa, which will not adhere to the healing tissue or sutures. Paper tape is preferred for securing the dressing because it is gentler on the sensitive skin around the ear, scalp, and neck.
You will also need supplies for cleaning and promoting a moist wound bed. Mild soap and tap water are used for gentle cleansing. Your surgeon may recommend a diluted solution of hydrogen peroxide or a half-and-half mixture of tap water and white vinegar for removing stubborn crusting. Cotton-tipped applicators (Q-tips) are needed to apply ointments and clean the area without contamination. Finally, keep a new tube of petroleum jelly or a similar healing ointment like Aquaphor on hand to maintain the moist environment needed for healing.
Step-by-Step Bandage Application
Always wash your hands thoroughly with soap and water before touching the wound to prevent bacteria introduction. If the initial pressure dressing has been on for the recommended 24 to 72 hours, gently remove it. If the dressing seems stuck, soak it with water or saline first.
Next, clean the surgical site gently with mild soap and water, using a wet cotton-tipped applicator or gauze to carefully remove any dried blood or crusting. Avoid aggressive scrubbing or picking at debris, as this can disrupt newly forming skin cells and sutures. After cleaning, pat the area dry with clean gauze, avoiding cotton balls which can leave behind fibers.
Apply a thick, continuous layer of the prescribed ointment, such as petroleum jelly, over the incision and any sutures, covering the entire wound area.
Cut the non-stick gauze to fit the size and curvature of the surgical area, ensuring it covers all edges of the incision. For wounds in concave areas, a small piece of gauze with a hole cut out (a “doughnut”) can be used. This allows the surrounding skin to support the dressing without pressing directly on the incision.
Secure the dressing with strips of paper tape, placing them to conform to the ear’s shape. Anchor the bandage securely to the skin without causing tension on the wound or irritation on the scalp or neck. The goal is to fully cover the non-stick pad to keep the wound bed continually moist.
Bandage Maintenance and Removal
The initial pressure dressing applied by the surgeon must remain dry and intact for the first 24 to 48 hours, or as instructed. After this period, the dressing should be changed once a day, or sooner if it becomes wet, soiled, or loose. If the old dressing adheres to the wound, moistening it with tap water or saline helps release it without causing trauma to the healing tissue.
Keep the surgical site dry during showering until your surgeon advises it is safe to wet the area. To prevent saturation, use a waterproof cover or bathe carefully from the neck down, avoiding direct water pressure on the ear. To reduce swelling common in the first 24 to 48 hours, keep your head elevated by sleeping with several pillows. Avoid sleeping directly on the operative side to prevent pressure on the healing wound.
Recognizing Post-Operative Complications
Some bruising, swelling, and mild pain are expected after Mohs surgery, but certain signs indicate a complication or infection. Monitor for increasing redness spreading outward from the incision line, or warmth that feels hot to the touch. A foul-smelling odor or the presence of thick, yellow or green discharge is a warning sign of potential infection. This discharge is distinct from expected bloody or yellowish watery drainage.
Severe pain that escalates instead of gradually improving should prompt a call to your surgeon. If excessive bleeding soaks through the dressing, apply continuous, firm pressure with clean gauze for 20 minutes without lifting to check the wound. If bleeding persists after a second 20-minute application of pressure, or if you develop a fever of 101 degrees Fahrenheit or higher, seek immediate medical attention.