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View Full Version : Moh's and flap reconstruction surgeries??


tsohl
10-11-2007, 07:39 AM
A friend of mine is having Moh's surgery for what I assume is BCC on the tip of her nose. A plastic surgeon is then going to take skin from her forehead to use in the reconstruction of the tip of her nose.

No one bothered to tell her that the healing time for these procedures is lengthy. She has a job that requires her to be before the public and she is freaking out over this recovery.

Can anyone tell me more about the skin flap surgery, how disfiguring it is and for how many weeks you look kind of scary??

Any information would be greatly appreciated.

xx Tsohl

gd3585
10-11-2007, 04:56 PM
Hasn’t the Doctor discussed this with your friend? During my initial consult with the reconstructive surgeon I was under the impression that it was a cosmetic surgery with immediate results… i.e. no disfigurement.

To my surprise when I awoke from surgery… the initial flap is grotesque and stays in place for about 4 weeks, until the flap generates its own blood supply. Mine was ‘up’ for 4 weeks. After this minor surgery I’ve been back for approximately 4 visits where they inject the scars with a steroid. Initially the patched area is swollen and very obvious over time it reduces but at no time has it not been obvious. The unsightly scar on my forehead running from the bridge of the nose to my hair line is indented and quite obvious.

Timeline; I had the reconstruction in April and will have the forehead scar cosmetically fixed at the end of November. Basically they are going to cut the scar out and sew the two sides back together. The ‘smoothing’ of the nose has been put on hold temporarily as my team of Doctors recently recommended radiation therapy. I peg my timeline at about one year.

I would recommend that your friend ask her Doctor her timeline and what procedure will be preformed at each step and most importantly ask upfront if they are recommending radiation. If so I suggest she have this before she starts the reconstruction. Radiation means fibrosis to the treated area as well as additional scaring all of which disfigures. I know first hand.

Ask upfront, I wish I had.

tsohl
10-11-2007, 09:30 PM
Thanks so much for telling me about your experience. My friend thought it was going to be a simple procedure, thought she might be kind of out of commission for a couple weeks, but then met with the second surgeon who indicated you can't have bandages over the flap, and that she couldn't predict any timetable because you never know how deep the surgery will be, etc. It all came as such a shock to her that she didn't absorb much else of what the doc was telling her

Were you able to go out in public during this time? Is there any way to cover the flap? The procedure really sounds a bit grotesque. Maybe it's not as bad as it sounds?? (she asked hopefully :confused: )

xx Tsohl

gd3585
10-12-2007, 10:50 AM
At first I wasn’t too sure how I should answer this, then I went back and looked at the pictures of me after the surgery and subsequent pictures; there is no way that you would want to appear in public. To imagine what I looked like, and keep in mind my surgery may have been more involved, imagine a finger sutured to you nose with a gash down the middle of your forehead, the flap on the nose has open stitches and the forehead is stapled closed with only steri-strips across the wound. There weren’t any bandages on the nose and a gauze pad soaked in vaseline around the blood feed running across the bridge of the nose. My first venture in public was a school play about 7 weeks after my surgery, I wore a hat to hide as much as I could but was still self-conscious.

Have your friend ask her Doctor to see some pictures of what she can expect after the surgery. The medical term for what I had was Paramedian Forehead Flap Repair.

For me most of the concerns were moot when I considered the alternatives; doing nothing was not an option and radiation is ineffective by itself on BCC.

tsohl
10-12-2007, 11:16 AM
My friend looking at photos online is what prompted me to write. I thought she was exxagerating how "monstrous" she thought it looked, but I did some research after posting and had to agree that the results are worth it, but going through the process has to be pretty tough!!

She liked the doc who would be performing the Mohs surgery, but then she met with the plastic surgeon who would do the reconsstruction, who "explained" things in a very rapid-fire way, leaving no time for questions. She thought it was going to be just a little repair job and was in no way prepared for hearing about skin flaps!! Of course, that is the worst case scenario. She won't know until the surgery how large the resulting hole will be.

She basically meets with people all day long in her work and has to go to court a lot so it isn't like even just appearing in public to a group of strangers you'll never see again!! And she can't afford to take a leave of absence during the whole healing process.

Thanks so much for your honest answers. I do appreciate it and I hope you are doing well. What a process!!

xx Tsohl

gd3585
10-12-2007, 02:24 PM
Thank you and Good Luck to your Friend

lonershark
10-14-2007, 03:03 PM
My friend looking at photos online is what prompted me to write. I thought she was exxagerating how "monstrous" she thought it looked, but I did some research after posting and had to agree that the results are worth it, but going through the process has to be pretty tough!!

She liked the doc who would be performing the Mohs surgery, but then she met with the plastic surgeon who would do the reconsstruction, who "explained" things in a very rapid-fire way, leaving no time for questions. She thought it was going to be just a little repair job and was in no way prepared for hearing about skin flaps!! Of course, that is the worst case scenario. She won't know until the surgery how large the resulting hole will be.

She basically meets with people all day long in her work and has to go to court a lot so it isn't like even just appearing in public to a group of strangers you'll never see again!! And she can't afford to take a leave of absence during the whole healing process.

Thanks so much for your honest answers. I do appreciate it and I hope you are doing well. What a process!!

xx Tsohl
I am in radiation therapy for bcc right now. Before I agreed to radiation I talked to a radioligist and a plastic surgeon. They both said the same thing that either way I go the results of not having a reoccurrence is about the same. 98-99% effective, but radiation left no big scar or any cosmetic reconstruction.

gd3585
10-17-2007, 12:59 PM
I was told the biggest drawback to radiation only was that they had to make an ‘educated guess’ as to the type and size of the tumor and if they’re wrong they may not get it all. In my case, to everyone’s surprise, it turned out to be 4 times larger then expected with perineural involvement which would not have been discovered without the Mohs surgery.

Because of the perinerual aspect I’m also undergoing radiation therapy which also has risks, mine extended into the bridge of the nose so now that I’m undergoing radiation I’m having considerable problems with the ‘scatter’ radiation to the eyes. My oncologist has changed the ‘plan’ twice now to alleviate the scatter.

There are trade offs to either method.

tsohl
10-17-2007, 02:25 PM
Thanks. Your information has been very helpful. I know this is all so scary and difficult to deal with. I hope you will be finished with the treatments soon.

colby88
10-18-2007, 11:24 AM
My Mom had Moh's surgery and reconstruction in 1990 on her left nostril and cheek. Half of the left nostril was removed and the cancer had spread in the soft tissue on her cheeck. The plastic surgeon used the top of her ear to reconstruct the nostril and pulled the skin on her cheek to close the hole. Essentially she had a hole the size of a silver dollar when Moh's was finished.
It looked grotesque prior to reconstruction.

The first ear flap on her nostril did not take so they used the top of the second ear. It didn't entirely take either. In the end my Mom was left with a smaller nostril and a surgical scar on her cheek that runs down to her mouth.

She's a beautiful woman so this was very distressing for her to go through. It's now been 17 yrs. and she still is conscious of it. Of course it had to be done just as it does with your friend but when Moh's is performed one really doesn't know the end result until they get all of the skin cancer. Reconstruction follows from there so the process can be difficult and lengthy.

Good luck to your friend.