Skin Graft over cartilage question & my SCC on ear story
I had Mohs surgery on my upper ear on 8/12. A skin (split thickness) graft was taken from my thigh and covered the wound. It seemed to be going well until last Saturday about 16 days after the procedure. I saw a hard white surface where the skin graft was, I was afraid the squamous cell was coming back, and anxiously waited until my scheduled doctor appointment three days later. Well my doctor said it was cartilage, not the SCC re-occurring. That made sense and was a relief. He told me to keep it lubricated and ensure it doesnít dry out. Well the cartilage exposure has doubled now form one pencil eraser size to two. The entire skin graft area is the size of a coin quarter. Apparently it is in the area of MOHS surgery that cut all the way to the cartilage. The skin graft is not holding there. My question is has anyone had anything similar with graft not holding on cartilage? I know my plastic surgeon (very prominent) is competent, but at that last appointment he gave me impression the skin graft would grow over that exposed cartilage. My Internet research tells me otherwise that a (Split-thickness graft) will not cover exposed cartilage. It sounds like a skin flap is what will be needed. Any experiences on this? Is there hope the exposed cartilage will be covered by skin on its own? I go back in two weeks for next appointment, so of course Iíll ask the doctor, But Iím still curious for any other peoples experience.
Iím happy to share my squamous cell carcinoma (SCC) story, for anyone interested (read on).
Iím 45 male, Irish-german heritage, who spent whole life in the sun from swim teams, lifeguard, 6 years in Hawaii in the Navy, golfer, athlete, outdoorsman, etc.. I have been wearing sunscreen and ball caps as an adult (mostly to prevent skin aging/wrinkling). Rarely did I intentionally protect my ears.
Well, early this summer around the end of May I noticed a cyst/pimple type of growth on my right ear. I started putting antibiotics on it hoping it would go away thinking it was no big deal. Unfortunately, it didnít go away but it got bigger to about the size (diameter) of a pencilís eraser. I promised loved ones I would get it checked out since it was not going away. Well my primary care physician looked at a few minutes, and said it was not good. He referred to me a dermatologist. It took a few weeks to get the dermatologist appointment. He again said it was not normal, and said it had to go. He biopsied it, shaved this wart-like eraser sized growth right off. The cut never healed right and a weird "Crater Lake" like growth grew back with the scab in the middle. Anyway 10 days after the biopsy he called and said the biopsy showed it was a squamous cell carcinoma.
He said since it was on the ear, he wanted Mohs surgery performed. And he was referring me to a specialist in this Mohs surgery. I had never heard of squamous cell or Mohs, no family history of any kind of cancer. It took two weeks to be seen by him, and of course he said it had to go and Mohs surgery was needed. I agreed and wanted the first available appointment he had which was two weeks down the road, and was finally performed on 8/10. Surprisingly going through all the hoops, referrals, etc. took maybe two months in all a long time.
The surgery is done in his offices and is not too scary. Basically they cut the growth/tumor out with a scalpel and using surgeons experience they cut just enough being conservative as they go. After each go around (cut) they take skin samples to see if there are more cancerous cells remaining, as you wait in waiting room they make slides and look under microscope. Then you go back in for a little bit more cutting as required. It took only two sessions/cuts to get to healthy skin in my case. The size of the wound on my ear was size of a quarter when done. This required him to do a skin graft. What they do is shave off a rectangular section of skin from your upper leg, then size it perfectly and sew it into the excavated Mohs hole. The skin graft site on leg is about the size of two postage stamps and is left to heal/cover up on its own. After the skin graft is sewn on the ear, a piece of formable plastic is cut to size and pressed to the contour of ear before it hardens. Then the plastic is sewn to the ear, forming a custom compression bandage to help the skin graft succeed.
After four or five days they removed the plastic shield from ear. Then on 8/18 I again went back to check the status of skin graft. It was looking okay at that time as skin grafts go. Now I am waiting on that exposed cartilage.