Skin Graft Care After Facial Melanoma Excision
For a skin graft on the cheek after melanoma removal, secure the graft with a bolster dressing that applies even pressure for 5-7 days, keep the area immobilized, avoid any shearing forces, and monitor closely for hematoma or infection which are the primary threats to graft survival. 1
Immediate Post-Operative Period (Days 0-7)
Dressing Selection and Application
- Apply a foam-based pressure dressing (such as polyurethane foam) that provides even, consistent pressure across the entire graft surface 2, 1
- The foam dressing absorbs drainage, protects against shearing forces, and maintains optimal moisture balance for graft adherence 2, 1
- Secure the dressing with a bolster technique using sutures tied over the foam to ensure the graft remains in complete contact with the recipient bed 1
Critical First Week Management
- Keep the dressing completely undisturbed for 5-7 days unless signs of infection develop 1
- Strict facial immobilization is essential—minimize talking, chewing (soft diet only), and any facial expressions that could create shear stress on the graft 1
- Elevate the head of the bed 30-45 degrees to reduce edema and prevent hematoma formation 1
Warning Signs Requiring Immediate Attention
- Increasing pain (suggests hematoma or infection) 1
- Foul odor or purulent drainage visible at dressing edges (infection) 1
- Fever or systemic signs of infection 1
Days 7-14: First Dressing Change
Assessment at First Dressing Removal
- Gently remove the bolster dressing at day 5-7 to assess graft take 2
- Look for complete adherence, pink color indicating vascularization, and absence of fluid collections 2
- Partial graft loss appears as dark, non-adherent areas that should be debrided 2
Transition Dressing Strategy
- If the graft shows complete take, transition to a non-adherent petrolatum gauze or continue with hydrophilic foam dressing 2
- Hydrophilic polyurethane foam dressings reduce pain compared to traditional petrolatum gauze, particularly in the first 3 days after dressing changes 2
- Change dressings every 2-3 days during this period 2
Days 14-21: Epithelialization Phase
Expected Healing Timeline
- Complete epithelialization typically occurs by day 14-21 for split-thickness grafts 2
- The graft will appear pink to red initially, gradually fading over months 2
Ongoing Care
- Continue protecting the graft from sun exposure indefinitely—melanoma patients require lifelong UV protection 3
- Apply broad-spectrum sunscreen (SPF 30+) once the graft is fully healed 3
- Moisturize regularly to prevent dryness and cracking 2
Common Pitfalls to Avoid
Do NOT:
- Remove or disturb the initial bolster dressing before day 5 unless infection is suspected—premature removal is the most common cause of graft failure 1
- Allow any shearing motion across the graft surface during the first week 1
- Apply excessive pressure that could compromise graft perfusion 1
- Neglect facial immobilization—even minor facial movements can disrupt graft adherence 1
Special Considerations for Facial Location
Anatomic Challenges of Cheek Grafts
- The cheek is a mobile area with constant movement from talking and eating, making immobilization critical 1
- Facial contours require careful bolster construction to ensure even pressure distribution 1
- Consider using foam dressings specifically because they conform to facial contours better than traditional gauze 1
Long-Term Surveillance
Melanoma-Specific Follow-Up
- All melanoma patients require lifelong surveillance for recurrence 3
- The surgical margins used (0.5-3 cm depending on Breslow thickness) aim to minimize local recurrence, but vigilance is essential 4, 3
- Examine the graft site and regional lymph nodes at every follow-up visit 3
- Teach self-examination of the graft site for any new pigmented lesions or nodules 3