back with another question re: WE closures

Posted By
1/12/2018 6:17pm
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Replies: 4

First, let me preface this with: I know this is a sort of ridiculous question. I know there are much more pressing questions on this board. But as this is all brand-new to me, I wasn't sure whom else to ask. So..

I've got wide excision surgery coming up in a couple weeks. One on top of my foot, the other on the outside (the very outside) of my ear. I've got a consultation with the plastic surgeon doing the closing-up part of it, and from what the onc-surg said, the plastic surgeon does this whole complicated thing. Now, I asked the onc-surg if he could just close it up and be done with it, but he wouldn't. Ok... So my question is, how do I get my point across to the plastic surgeon that I'm not after an aesthetically-perfect closure? I really, really, honestly just want him to stitch the damn thing up and let me go on to the next steps in this whole journey.

Please help, because I feel like very few of the doctors I've seen so far in this journey are actually listening to me. I'm 45. I know myself very well at this point, and can assure you, I don't care what my ear looks like, I just want the cancer gone.




What you have to realize is that they remove a bunch of tissue.  So it's not that the plastics guy main goal is aesthetics, his main goal is figuring a way how to close the wound in a difficult area.  He's approaching it from many angles, only one of which is aethetics.  His goal is to take the best margins he can and still close the wound!  BTW, timing really isn't a consideration, getting it done faster isn't going to change prognosis.

If your insurance pays, go for it!  I agree with the previous post about the necessity of a good closure. here is the perspective from someone who had a Wide Local Excision on his foot from a 3.7 mm deep melanoma.

For invasive melanomas with Breslow thickness ≤1 mm, the recommended clearance margin is 1 cm of normal skin. For melanomas with a depth between 1 and 2 mm, surgical margins of 1 to 2 cm are the goal. For melanomas between 2 and 4 mm in depth, margins of 2 cm are recommended.

In my case, the margin that the oncologist was trying to achieve was 2 cm. After the oncologist did the best she could do in removing the desired margin of tissue, she then turned me over to the plastic surgeon. His job was to close the wound. The reality is that you can only stretch skin so far before it will just rip, so depending upon the size of the gap and the location on the body, a skin graft is often necessary.

In my case, I had a hole on the heel of my foot about 3 inches in diameter, and down to the bone and cartilage. To close my "wound" required a full-thickness skin graft which was taken from my upper thigh. The procedure involved microsurgical connection of the blood vessels of the graft to the blood supply within the remaining tissues of the foot.

One big reality that you must accept in dealing with a medical procedure is that the doctors have protocols for performing all procedures, which have been developed over many years, and the doctors will adhere to those protocols in order to ensure the best outcome. They may listen to their patients' requests, but ultimately, they will almost invariably follow the protocols dictated by the circumstances. 

You really need not try to be the "hero" in saying that you do not care about the aesthetics of the outcome. Under these circumstances, the doctor will do the absolute best they can do...nothing more...nothing less. Also, you want the doctor to feel you are working with them, not against them. As a board-certified plastic surgeon, the outcome they achieve for you is their "work" and they will want it to meet the standard of care that they, as a medical professional, have been trained to deliver. 

Mark (IIA)

Thanks, everyone, for the thoughtful replies. As I said, this is all new to me. For the record, my foot was 0.3mm and the ear was 1.3mm, so I've been told to expect 1cm around those. Rest assured, there's no "hero" here; I just prefer the simplest, most direct approach. Thanks again for the replies,