"Mohs surgery and aftercare"

I underwent Mohs surgery at QVH in November 2017. The day of the surgery went well, though with some waiting between the initial excision and the subsequent reconstruction later that day. How good the skin graft is will only be apparent after around 18 months.

The aftercare following the surgery has not been good. Having surgery and a skin graft on your face brings with it anxiety. I'm sure this is a commonplace operation, and from what I've read, aftercare is critical to the final appearance of the graft. But information from the hospital on self-help following the operation is lacking. It would be helpful, and allay a lot of anxiety, if a simple A4 information sheet were provided by the hospital detailing aftercare (massage, use of silicone, etc.), as well as a roadmap of what to expect in months 1-3, 3-6, and so on.

I attended the dressing clinic three times following the operation. The nursing care was sometimes caring, but brusque at busy times. The brusque treatment coincided with my first visit post-graft, and my first sight of the graft. There were also inconsistencies between the advice given – at my second visit (when the dressing was removed) I was advised to allow the scabs around the graft to come away naturally with bathing. At my third visit – one week later – the nurse picked away the scabs that remained in place. I had a couple of biopsies taken during the reconstruction. On one of these – a punch biopsy – a dressing had been placed in the hole. It remained there, unnoticed by nursing staff until my third visit, when it was removed.

My histology appointment was 3 weeks late (7 weeks post-surgery, rather than 4). The surgeon I was scheduled to see was running 45 minutes late. I can see that these things happen. However, he was abrupt and, while he gave me the results of the biopsy that had been taken during the operation, he failed to tell me anything about the histology of the cancer that had been removed. (I had to follow this up by going to my GP for the information.) I found the surgeon in no way reassuring as to the current state of the graft, which is rather raised. He gave me no information about what I could expect over the next few months, other than saying that it would change. When I told him that a dressing had been left in the punch biopsy for 3 weeks, his response was 'It looks alright now, doesn't it?'. It does look alright, and it had not become infected. However, healing had been delayed by a couple of weeks because of the dressing. I raised the issue because I thought it was something that should not have happened and should be addressed so that it didn't happen in future. I felt his response was patronising and poor.

I chose to go to QVH for Mohs surgery as my perception was that it was at the forefront of plastic surgery within the NHS, and I would receive good care. I have to say that, based on my recent experience, I would not choose to go there again.