I couldn’t find anything much about skin grafts for oral cancer/head and neck cancer on the internet so I’m writing about my experience to help others. I’ve had two recently.
Double thickness skin grafts they were called. The removal of both the epidermis and the dermis. Small surgeries but long periods of nil by mouth on an ng tube – much longer than for flap surgery where the flap has its own blood supply built in.
I believe that free flaps such as I’ve had for my tongue are more common when removing a head and neck cancer and reconstructing the defect. Recently, however, I have had two skin graft operations, minor events compared to flap surgery but not uneventful.
The first one was scheduled at the last minute and I didn’t receive much info or even ask for it. It was a “sulcoplasty”. To cut a long story short I had a large bandaid sized piece of skin removed from my clavicle and inserted onto my lower gum. A prosthesis was then screwed onto my four implants. I had putty placed around the prosthesis so I couldn’t get even the slightest glimpse of the graft.
After 10 days on an ng tube the prosthodontist unscrewed the prosthesis and hey presto, the skin graft was looking great. He looked so relieved that I realized that there had been a possibility of it not taking.
A few months later, I developed a little tumour inside my right cheek. My surgeon removed it and sewed a small piece of skin from my neck onto the cheek and covered it with a cotton wool bandage infused with Friar’s Balsam. This was secured by sewing right through to my outer cheek where a small circular piece of silicone kept everything in place.
I looked like a lopsided chipmunk for 4 or 5 days until the swelling subsided.
After a week I had the external stitch taken out as well as the soggy cotton wool bandage. Another week on an ng tube was advised though because the skin graft, which had taken well, looked tender even to me. The ng tube and nil by mouth are very hard for me to handle. My social life depends on COFFEE!
What I learnt about the skin graft this time is that it is preferable to cutting out the little cancer in the inner cheek and just leaving a raw wound which would scar and contract and possibly make my limited mouth opening even tighter. There is no scarring with the graft – in fact I saw it yesterday and it looks pretty good.
This second time it has been more nerve wracking because I had learnt that these things can fail after seeing the relief on the face of the prosthodontist. I’d been warned it might fail, too. After all it wouldn’t have the weight of the prosthesis pushing down on it to make the blood flow from graft to recipient bed.
I was scrupulous about nil by mouth and after I had the ng tube taken out I lived on Ensure milkshakes, a little bit of smooth soup and a big bit of ice cream. I did try a spoonful of noodles and a poached egg on Friday night – I dislike eggs and try to disguise them in something else.
After two weeks the graft had become white and after I saw the surgeon on Tuesday it seemed to become whiter and looser. I was in denial and pushed it back with my finger. I think I bit it a few times. Horror of horrors on Friday night when I cleaned my mouth after the egg and noodles, the whole thing came partly out like a wet cloth hanging by a thread. I should have known it wasn’t the skin graft but I didn’t. Below is what it looked like when I pulled it out. Gross. It was still attached to the back of my inner cheek.
Panic, panic. It’s awful when you live alone. Then I messaged a few people and luckily my surgeon was doing a Saturday clinic and all was well. The white rag was the surface layer of the skin that had sloughed off in one piece. I’ve never seen anything like it.
Oh and this time the donor site is small and hardly noticeable now. It’s on my neck. The previous larger donor site is a thin line of a scar.
The skin graft was a good option for me – less invasive – the surgery was under local anaesthetic but there was swelling, there was soreness and the ng tube nearly drove me mad!
But do you know what? I’ve forgotten about it now and I’m back to my normal life,
