Recovery from Wide excision + skin graft (lower left leg) + SLNB

Posted By
NicoleinVA
7/27/2011 9:06pm
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Replies: 21

Hello all,

I'm scheduled for lower left leg wide exsicion (+skin graft) and SLNB on 8/11.  I'm equally as scared of surgery/recovery as I am of outcome...has anyone had this?  FYI, I plan to have drainage tube for SLNB.  

If so, can you share your recovery/experience with me?  I'm the mom a busy 5 year old starting kindergarten, I have a f/t job and a husband that travels...not a good combo for bed rest.  

Also, do you think I'm at risk for lymphedema?  Other than this I am healthy and in shape..should that be an asset in recovery?

I am grateful for any feedback; many thanks!

 

Nicole

Nicole,

About the possibility of lymphedema: I know that the SNLB procedure was developed as a way to determine if cancer has spread to the nearby lymph nodes without having to remove all the nodes and therefore putting you at risk for lymphedema. They only remove a few nodes that they have identified as the sentinel nodes - nodes that are first in line to get the cancer if it has spread. Most people don't develop complications like  lymphedema from the SNLB. What does your doctor say about it?

Best regards, Steve

 

Hi Nicole,

I can only share my own experience which was on my chest.  They cut about 1/2 my right breast out and I have about a 4" incision under my arm where the lymph nodes came out.  I was sooooo scared and anxious!!  When you get to the hospital and they get an IV in you ask for something to calm your nerves.  I don't remember anything after that!  The stuff really works.  After surgery I was up and walking around no problem, just a little groggy.  Since your surgery is on your leg you obviously won't be up and walking around but the pain wasn't bad for me.  They'll give you a prescription for pain killers, get those asap!!  I haven't suffered any lymphedema in my arm at all!  Some people do some people don't.  I know someone who had the drain and it wasn't bad!  Being that your healthy and in shape will definately help you. I'm pretty healthy too and I healed in no time!!  I didn't get a graph but almost wish I did because my skin was streched together to close the wound.  The tightness was/is the worst!

Looking back now it wasn't bad at all!  Our minds play with us with the fear of the unknown.  I had never had surgery before so I was really scared.  Just remember to ask for something to relax you!!! 

The bottom line is this is better than having Melanoma grow on you!!  K

Keep us posted!!

***HUGS*** You'll be ok!! 

Denise 

Cancer Cannot cripple love, silence courage, destroy friendship, shatter hope or conquer the spirit.

Hello Nicole,

 

I'm sorry to hear about your upcoming surgeries....I can't speak to the SNLB procedure, but I did have a full thickness skin graft on my right ankle last October for a melanoma in situ.  If you want more feedback regarding the skin graft procedure and recovery, let me know.

Hope all goes well and you get good news,

Teresa

Hi Teresa,

 

I am having something similar done as described above.  Only no SLNB and it is on my right ankle. 

Jenn G.

Hi Teresa,

 

I am having something similar done as described above.  Only no SLNB and it is on my right ankle. 

 

Jenn

Jenn G.

Teresa or others, I hope you are all doing weel and still available to this thread, I could use some comments. My wife is scheduled for a large full thickness skin graft on her ankle next month. I'm looking for information about the experience. Not melanoma but sarcoma. Doc needs to establish better margins by removing about a playing card size of full thickness skin.

What was the donor site ? Was there a need for a second split thickness graft for the donor site ?

What was recovery like ?

Dr Slingluff (UVA) did a much more extensive surgery than it sounds like they are planning on you.  If it is "just a sentinal node check" and they don't need to go extensinely into the lymph chain,- you should do fine.  In my first operation on that area, tha local General surgeon removed the one node  that I had found.  It was by then the size of a golfball.  My wife and I went shopping on the way home from that outpatient surgery.  Six weeks lter, after Dr Slingluff taking out my iliac and inquinal lymph nodes and having to go deep, they had me on my feet that evening and I stayed in the hospital for about three days.  After a few days at home I was fairly active. (Had two big drains installed.)  The left side of my abdomen is now two inches mnarrower than the other side.   I was cut on the side from about an inch lower than my navel to down below the abdomen. 

The main lymphedema problems are most apt to occur if they have to take a long chain of nodes out and you have a major disruption of the lymph fluid path.   The main thing will be to keep your leg elevated as much as possible , so hopefully your job does not require to be on your feet too much.  If there are just a few lymph nodes removed and you keep the leg elevated as much as possible, there should be no large problem.    I was active, but careful and have had no continuing lymphedama problems.  Feel free to email/message me if you want.   I will be glad to talk telephonically if you would like.  Yes, being active and in good shape is a definate advantage.

JerryfromFauq Stage IV, not NED and busy with life.

I'm me, not a statistic. Praying to not be one for years yet.

Hi Nicole,

Sorry you are having to go through this.  Many have said the SLNB isn't so bad; I agree.  I did have some fluid for a while, but not too much.  I had a little pain, but not so much.

To me the scaries came when I saw my skin graft.  It was ugly.  Srsly.  Plastic surgeon told me it would be, but I was pretty freaked.  Now it is much better and nobody notices, but you wouldn't have convinced me of that 7 years ago. 

Now I sound really vain!  Just wanted you to know that it will heal.  The doc will prolly keep it immobile for about a week and allow the graft to 'take'.  I had a cast on my hand.  It went through various stages of ugliness as it healed and it itched like crazy. There were lots of tiny stitches all the way around that mostly dissolved on their own.  I kept it covered because people kind of freaked out as it was obvious on my finger.  The most uncomfortable spot was the doner site on my hip.  Worst road rash ever!

It is a process, but you will be fine.  Take a little time to rest and take your pain meds!

And take good care, k.

And remember, no matter where you go, there you are. Confucius

Hi again,
I agree with K. Re : the skin graft is seriously ugly! However with my full thickness skin graft, you don't get the road rash effect from the donor site...My donor site recovered well, with minimal pain and has left a long scar in the fold of my groin area.

The actual skin graft on my ankle took much longer to heal and was quite painful. The plastic surgeon said to plan for three days off work....lie!... I ended up off work for two weeks and when I returned, I used an ottoman to keep my leg elevated for another couple of weeks. ( I'm a counselor). When ever I walked a little extra, I always paid for it!!! Take it very easy and try to get someone to help with the kids.. I have permanent numbness below the graft site, and suffered from a lot of edema for several months in that ankle and foot. There were also shooting pains as nerves regenerated during healing. I also developed a weird, and ugly rash around the graft....surgeon had no clue how to treat it, I finally went back to derm's office and they prescribed a steroid cream that fixed it quickly. It's important to keep the graft site moisturized and protected...I have photos of the graft in various stages of recovery... The first ones are very graphic and ugly, but currently it
looks good... for a half dollar size scoop out of my leg:)
Good luck!
Teresa

Hi Nicole. I had the same thing done on the same leg. I was off from work for about a month. Find out with the SLNB if they are moving the sartorius muscle. If they are that means they are going pretty deep and that's why my recovery took a bit longer.

My surgery was back in November (2010). The right leg (where they took the graft from) healed up pretty quickly though even after 8 months now you can still see the "patch" where it came from. That healed up pretty quickly though and there wasn't any pain.

How big an area are they taking out? My left calf has about a 4 inch by 5 inch "divot". Luckily I had my wife to change the bandages at first cause I couldn't look at it for awhile.

The drains were a big pain but doable. Had my share of pain meds, but really more because they moved that muscle than anything else. 

I've got lymphedema but not too bad. I usually only wear my compression stocking (knee high) when it hurts or flying (I travel for work quite a bit). 

I'm back at the gym though and wear it there as well. More to cover up than anything. You wouldn't think guys would be vain but I don't want people staring at it.

Wish that was the end of my story but I'm one of these rare cases in that I keep getting new satellite melanomas right on the fringe of the divot. So far I've had about 20 removed. We're using something called DPCP that they've used in Australia with some  success but right now I'm still battling.

Best wishes and my prayers will be with you. The first couple weeks are tough but you'll get through it!

David

I should clarify - I had the graft/wide excision snlb done first, then had 1 node that came back with micro metastises - then they did the groin resection and that's when they moved that muscle. Not something they would normally do with just the snlb....

The last year has been kind of a blur to say the least and sometimes I have a hard time keeping up!

David

Thank you so much for all the posts!  You've give me alot of comfort with your replies.

I don't think I'm fully prepared for how scary looking my leg is going to be, but as least I know it will heal.  I'm looking at a 2 1/4 x 1 1/4 divot...lovely.  The jury is still out whether I have melanoma or very atypcial nevi (3 conflicitng path reports), but this needs to come out and if the node biopsey comes back negative, than I'm happy to walk away from this with a scary leg.  I'm scared it will come back, but that's another topic...

I'm a runner and running is 'my therapy' so to speak...so this one of my bigger mental obstacles to overcome.  Will be able to run again?

I had my PET scan today and meet w/surgical oncologist on Monday to review as well as final questions for him before my 8/11 surgery.  I meet with plastic surgeon on Tuesday.  I was so overwhelmed at my last appointment that I didn't ask enough questions.

Again, thanks for all your support and replies...this forum has truly been a god-send to me and my husband.

Nicole, even with the huge "divot", the groin resection, and weekly new satellites appearing, I'm out there every weekend playing basketball with my 3 boys - is it sore the next day? Sure, but not that bad. I've never been much of a runner but I have no doubt I could if I wanted. I spend more time on the bike and elliptical machines and doing some weights at the gym. It did take a while (especially with basketball - jumping and stuff) where I felt confident that I could put all my weight on it, but that was all in my head.

The one thing I do have a hard time is doing a full squat. Due to the lymphedema I can't bend all the way down - maybe about 95% but that's it. My Onc Surgeon said I could do as much exercise as I wanted with no limitations.

I don't think you'll have any problems returning to running - just heal up first!

David

Sounds great David.  The only reason I cannot run now is that In 1980 both my legs were broken up and I  was told I should not be able to walk again. So I don't do any real running, but do walk good on the level.   Nothing to do with melanoma!

I'm me, not a statistic. Praying to not be one for years yet.

Write down all your questions as they come to you.  Take someone with you to your appointments too.  I honestly don't remember much either in the last couple of months.  Always ask for copies of your pathology reports, scans, mri's, etc.  Very good advice I got from this site!!  I look at my PET scan all the time.  Kinda cool.  :)   It's good to have too if you need to see another doctor or specialist. 

Good luck with your surgery and you have my positive thoughts going your way!! 

Denise

Cancer Cannot cripple love, silence courage, destroy friendship, shatter hope or conquer the spirit.

Thank you David!

I don't want to lose my sanity, which will happen if I can't run again.  Again, I appreiate all these responses...it's easy to get caught up in this and forget that, yes life will go on.

Hi Nicole, my name is Nicoli, call me Nicki. Bunch of us "nics" on this site lately.

I had my surgery and skin graft on my scalp so I can't address most of your questions. But I strongly urge you to get full time help. Contact all relatives, church, neighbors. No way can you do this and take care of a preschooler.

Just my opinion but if you could send the kid away to relatives for a few days. Little ones have a hard time seeing Mommy sick. Mommy is the strong one, Mommy is the hero. It can be traumatic for them. My youngest is a 19 year old 200 pound tough guy who almost fainted when he saw my last surgery. He also would not come visit me in the hospital when I did biochemo. Kids take it hard.

Praying for you right now for a speedy, uncomplicated recovery. You are in the right spot for education, encouragement and support.

Nicki, Stage 3b

Be strong and take heart, all you who HOPE in the Lord. Ps. 31:24

Sorry that you've joined us! I had WLE in groin and SLNB (2 nodes from left and one from right) in same procedure. Graft not required because of location. I had no lymphedema from that surgery and needed no drain for the same reason. I was careful for a few days but kept up many of my normal activiities, just didn't push myself so as to allow my body to heal. Hopefully, everything will be clear and that's all that you'll need.

I had a subsequent inguinal dissection and drain and swelling from that. My surgeon referred me immediately post-op to a lymphedema clinic. It has been extremely beneficial for both the reduction of the surgical swelling and massage of scar tissue so that it doesn't solidify. I haveonly  just been fit for a compression garment to make sure that all of the sugical swelling is controlled and doesn't develop into actual lympedema. Up until know, I kept wearing the stocking from surgeryThat clinic has educationed me about self manangement and trained me to do self massage. These are both very helpful.

Speak with you doctor regarding your own situation. There are some good options for you!

Be Not Afraid-God is with you always
Stage IIIa

Hi Nicole,

I had a very similar situation to you six months ago and really needed as much information as possible.  I think everybody reacts differently and I read a similar story of a girl who described the recovery period as "the worst pain in her life".  I didn't experience pain at all!  Also, the tracer injection is often described as excruciating - I found it more like a bee sting.  I dont think I am particularly great with pain, it is just a different experience. (I was quick to get an epidural in labour!)

My melanoma was on my left foot and I had a skin graft.  This was rolled and dressed by the district nurses on a daily basis over Christmas and New Year and I wasn't allowed to walk apart from to the bathroom for 4 weeks.  I dont know if this was because of the lack of doctors around who would take me off bedrest without my surgeon seeing me over this period though.  I do know that if you put your foot down it is much much harder for it to heal.

The SLNB site was fine although I do have ongoing discomfort/achiness in the groin area. (although this is mild).  You will have no problems with running but obviously need to plan for the recovery period.

I agree that you need as much support as possible.  My then 2 year old and 12 week old baby needed huge amounts of care and in the end we hired a nanny for two weeks so my husband could return to work as my mother in law was returning home.  I had never had a nanny but it was really great if you can afford it.   In the end it was much better for the kids than when we were cobbling together all sorts of family and friends for help, plus you risk burning out your support system.  The bottom line is though that you are going to need some serious help during this period. 

I hope it all goes well for you, often the fear is much worse than the reality.

Hi, Nicole

 

I had a WLE and SLNB on June 21 also on my lower left leg!  I am 41, a runner and train with weights.  I have not had the best out come but my surgeon is completely baffled why I have had problems.  I was recovering nicely until 2 weeks after the surgery then I started swelling (from the excision site and down).  The swelling lasted 12 days and was unbearable.  Just think of stretching a gaping wound. It felt like I was being stabbed in the leg.

 

My skin graft did not take.  More than likely the swelling was the culprit as it restricted blood flow.  I am scheduled to go in on the 11th for a regraft.  I have had swelling in my foot since but it is bearable.  I am hoping once the second graft is done and I start to heal that I won't have to deal with it any more.

 

Like I said, my surgeon completely expected me to be back running now .  I am sure you will do fine but I was not prepared for the scope of surgery and what my leg looked like.  I am now over the vanity issue and just want to get on with my life where my life is not centered around my leg!

Thanks for all the feedback...you all are wonderful.  Leigh, I really hope the re-graft takes for you; you've been through alot.  Please keep me posted...lots of warm thoughts/prayers that 8/11 is a great day for both of us.

Again thanks...all these replies have brought me alot of comfort.