Mohs Surgery and Forehead Flap Nose Reconstruction

This video is intended to help others who may be going through this process of Moh's skin cancer removal and the forehead flap nose reconstruction. I was unable to find much information about it before I underwent this procedure so here is my experience.
I had been to 3 doctors who told me the sore on my nose was not cancer so the area of my nose that was affected was significantly larger than it would have been if treated sooner.
The first step was removing the cancer. I went to Dr. Ammonette in Memphis, TN. This was done in his office with a local anesthetic. I have to tell you that the most painful part of this whole ordeal was the novicain injections. They about put me on the roof, but after that, no pain at all. What they do is take the area that is the doctor's best estimate of the area with cancer. They biopsy that tissue and see where they need to take additional tissue. That process is repeated until the biopsy is clear. This helps them take the minimal amount of tissue.
I was sent home that day with just a bandage over my nose. It did not hurt. It looked awful but I took a shower and cleaned it out very well and headed to my surgeon for the reconstruction the next morning.
The reconstruction was done by Dr. William Young of the Otolaryngology and Facial Surgery Center located in Jonesboro, AR. They have a wonderful staff by the way.
The surgery was done under general anesthesia so I can't tell you anything about that part but I really don't remember anything until very late that afternoon. What they did was to take a section of my forehead, (leaving it attached at an artery by my eyebrow for blood supply) and bent it down over the area where the cancer was removed and stitched it down. There was a hard and nasty smelling bandage on it for only a couple of days. I was very glad to be rid of that. The incisions were easy to clean by taking q-tips and soaking them in peroxide and gently scrubbing. Don't worry. It doesn't hurt.
One the bandage was off and I saw the "trunk" it was a bit shocking. I found that the best way to keep it clean was to either go to the kitchen sink hose sprayer and really hose it down or a removable shower head works well too when you're in the shower. This trunk seeps and oozes a lot so it's important to keep it clean. The sprayer allows you to get the back of it real well. Keep it moist with the Toposporin (not neosporin).
The next step was to have the stitches removed from my nose and forehead. It was a relief because they were becoming itchy and irritated.
This period between the removing the stitches and removing the "trunk" seemed to take forever. Over time, the trunk began to shrink and ache a bit. It obstructed the vision over my left eye and was overall annoying.
The next step is removing the "trunk". This was done under a twilight anesthesia so I do recall some of it. During this process, Dr. Young also did what he called "de-bulking" on my nose. He opened up one side of the new nose area and cut away some of the underlying flesh underneath the skin. Everything was stitched back up and sent me on my way. I was very concerned that the new flesh was so blue, but it turned out to be normal. From there on it was just a matter of keeping it clean, having the stitches removed and waiting for the healing. I have just gone in for my 6-week followup and all is going according to plan.
I just want you to know that there is light at the end of the tunnel and so keep a positive attitude, all will turn out fine.
A special thank-you to Dr. Young and his staff for taking the time to develop these skills. When you look at what they started out with, the fact that I have a nose at all is truly amazing.

Category:

Education

Tags:

• forehead flap
• skin cancer
• mohs
• nose reconstruction

[carlotacarver]

No, my eye wasn't swollen afterward, but I have learned through many who have responded to this video that everyone's experiences vary. The only swelling I had was at the forehead. That area stayed tender for a full year afterward.  Even now, it feels bruised. I know you hate that cast. They're uncomfortable and they smell awful! Hang on... The end is coming!

[Kfolkl12]

Thanks for the video! My mother is going through this process and your video is so helpful. She has had her flap connected for almostt 3 weeks, and the third surgery will be this week. How long did it take you for the color of the flap to begin to match the color of your nose? She is also anxious about it turning blue once it is detached! How long did it take for the discoloration to go down?

[carlotacarver]

@Kfolkl12

They disconnected my flap after a month. I was very concerned that it was so purple/blue but that is normal. It takes a while for your nose to develop all those little blood vessels and capillaries that actually create the natural color we are used to. I used some of that make-up used to cover those port stain marks etc. That works pretty well. If you look at me now, you'll really have to go up close to see the difference. Tell her it will be fine & show her my now photo

[marjmmn1977]

@carlotacarver

My surgery to get this flap disconnected is the 23rd of Feb. After 11 long weeks with this on my face, I will be so happy to look (somewhat) normal again. I am also worried about it being discolored. Can't be any worse than I have looked..ha ha! Hope I can find that make up you talk about! So for anyone else out there, yes, there is light at the end of it all, but I can see that some situations take a little less time that I did.

[carlotacarver]

@marjmmn1977 You are going to be SO relieved when they finally do remove the trunk. By now yours must have shrunk a lot and be very tight. It'll feel so good you won't care if your nose IS purple. It's only like that for a little while. You're over the worst of it. I just finished my last laser treatment. My hair is too light and it didn't work but it did eliminate the very red area around the scar and it's much less noticeable now. Good luck to you!

[marjmmn1977]

Going on 6 weeks with this flap connected..looking at about another 3 before it's disconnected at least I'm hoping.  I keep looking back at your video to see what to expect! Overall, most people can't believe what I've been going through, so we're pretty tough people those of us who have this done!!!

[carlotacarver]

@marjmmn1977

Hang on... You will be happy with the results. You know.. we could have been left without a nose. I am so grateful for this procedure.

[marjmmn1977]

@carlotacarver Looking to see if your eye was swollen after the division. My eye is almost swollen shut and I have a cast on my nose. You looked fantastic after you got yours divided!! I didn't actually think it would be this bad, but thankful it's the last and can't wait to get this cast off my nose next week!! See what's under there and hopefully release the swelling in my eye. Your forehead, I believe you mentioned it was bumped out. Mine is too.

[marjmmn1977]

@carlotacarver

Thanks for the reply! Yes,as a matter of fact,it is very tight and pulls up the side part of my nose.I pointed that out ot the dr. and he said it is scar tissue contracting and the fact that it is still attached. It should move down once cut,to make the side nostril look even with the other side. Just imagine what it will feel like to wear my good ol glasses again and the relief of it gone. Even though it is going to be full general anesthetic again..will let you know how I do!

[carlotacarver]

@marjmmn1977

There is a difference between the laser and electrolysis. The laser actually zaps and fries the hair follicle where with electrolysis, they use a tweezer type dealie and electrocute the follicle. If this doesn't work, I'll try that. Oh, and the laser will also zap out those little surface blood vessels that make the scar stand out. I recommend that highly.