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Skin graft healing on scalp
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Skin graft healing on scalp

› Forums › General Melanoma Community › Skin graft healing on scalp

  • Post
    • March 14, 2020 at 7:50 pm
    Tlynam
    Participant
      Five years ago I had an excision and full thickness skin graft on my scalp, about five inches in diameter. The graft has never fully healed and blended in with the rest of the scalp. Instead it is prone to small skin tears, which causes some bleeding and a lot of very red spots. My dermatologist has tried several things, including a topical steroid lotion. I went to a wound treatment doctor for a while. I have tried several over the counter skin lotions. But none seem to work. I always have several very red spots and some blood spots as well. There is no hair to cover it. Needless to say, very frustrating. My melanoma is gone but the skin graft doesn’t want to heal. Has anyone had this problem and have any suggestions? Thanks.
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    • Replies
        • March 15, 2020 at 3:16 am
        lkb
        Participant
          Tlynam, I’m sorry to hear about the difficult graft. My own (from 10/31/17) has healed, but the WLE still looks like a scab. The docs and nurses have told me that it is sometimes the way of scalp sites, because the wound cannot entirely close as it might in an area where there is more skin to pull around. May I assume that you keep it covered every time you go outside? Congrats on the melanoma being gone. I wish you luck with the graft!
          Lisa
          • March 15, 2020 at 11:14 am
          Hitchens
          Participant
            Hi Tulsa

            My graft on my scalp was quite large as well. I returned to my plastic surgeon a year and 2 years after receiving graft and he closed the graft so now it is barely noticeable. Basically he removed the graft with the skin the was originally on my scalp. In addition the indentation was also substantially reduced.

            Good luck

              • March 15, 2020 at 4:37 pm
              Tlynam
              Participant
                Thanks. i don’t understand what you mean when you say he removed the graft and replaced it with the skin that was originally there. Wasn’t the original skin removed? Can you please clarify?
                • March 15, 2020 at 9:32 pm
                Hitchens
                Participant
                  The surgeon cut the graft and stretched my skin that was always on my scalp. The Graft (bald spot) was removed by stretching the skin that always existed on my scalp. It was a similar procedure they would use for a facelift. The skin they removed was the graft.

                  I hope that helps explain

                  • March 16, 2020 at 4:38 am
                  lkb
                  Participant
                    Hitchens, that’s interesting. So, does hair now grow where the bald spot was? Pain level? Recovery time?
                    • March 16, 2020 at 9:40 am
                    Hitchens
                    Participant
                      Yes hair grows because the site of the incision is covered with hair covered scalp skin that was stretched. Both follow up surgeries were done as minor procedures with local anesthetic. There was minor pain (1-2) on the first few days after due to the tightness of the skin being pulled together and sutured.
                      Arguably the two worst parts of the procedure were listening to the surgeon explain what he was doing and why he was doing it to his residents and smelling the cauterization.
                      • March 16, 2020 at 9:43 am
                      Hitchens
                      Participant
                        Sorry I left out recovery time. I returned 2 weeks after each procedure to have sutures removed. I had to wait 12 months after each surgery including graft to have the site closed. I did not miss any time from work for the follow up procedures. Pain was minor Tylenol for the first couple of days
                        • March 20, 2020 at 3:30 am
                        lkb
                        Participant
                          Thanks for the info. I ‘m glad it went smoothly.. I discussed a reconstruction with a surgeon at some point, but dropped the idea after I had recurrences near the WLE. We’ll see.
                          • March 16, 2020 at 2:31 pm
                          Tlynam
                          Participant
                            Hitchens, thanks for the info. How wide in diameter was your graft? Mine is about 5 inches and so I think is way too wide to stretch existing skin over it to cover it. On some of my previous scalp melanomas I had that done. But after the fourth melanoma on the scalp, my doctor said the protocol was to excise a much larger area and do a full thickness graft. It was too big an area to stretch the adjacent skin. But the graft doesn’t fully blend and mesh at the margins and is prone to redness and small tears.
                            • March 16, 2020 at 3:23 pm
                            Hitchens
                            Participant
                              Hi Tlynam

                              My primary was 1.7mm thick so 2cm was removed on both sides and scraped to the skull. Due to the diameter of the primary the ellipsis was over 6 inches in length. Best way to describe I had a 6 by 2.5 inche bald spot (divot) removed from scalp. Now it is gone. It took 2 surgeries. I could go back for a third but the difference it would make is negligible

                              • March 18, 2020 at 12:55 am
                              Tlynam
                              Participant
                                That is a great result. Congratulations. Sounds like I should have used your surgeon.
                              • March 17, 2020 at 1:42 am
                              Treadlightly
                              Participant
                                Tlynam,

                                So sorry to hear what you have been going through. I had a full thickness skin graft 10 years ago on my heel. My plastic surgeon told me that he purposely put extra skin on, which left the graft a bit floppy, because he said the post-op swelling can cause harmful tension on the stitches. Then, after the initial surgery healed, about a year later, my doctor did another procedure where he pulled it tighter and trimmed off the access skin from one side of the graft. All in all, the outcome was fantastic, and the edges all healed very well.

                                I have seen where plastic surgeons have implanted a tissue expander, which is like a balloon, below the skin next to the graft, and then injected saline gradually into the tissue expander which causes the skin to stretch. Then they can go back and remove the tissue expander, and pull the skin tight to try to improve the perimeter continuity. It seems like a lot to go through, but in the end it could be worth it. Also, if successful, it could reduce the size of the graft.

                                Best of luck,
                                Mark 2A

                                  • March 18, 2020 at 12:52 am
                                  Tlynam
                                  Participant
                                    Mark, thanks . That is interesting. After several surgeries on my scalp, I am hesitant to go back and have another. But the expander suggestion sounds promising. I will look into it.
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