WLE skin graft photos *not for the squeamish*

If you've found this post, you're probably wondering what it looks like when you have a wide local excision with skin graft for melanoma. Specifically, this WLE is on the back of my right calf and was 9.5cm wide originally although it closed down amazingly. The donor site for the graft was on the side of my left thigh. If you have time, read the preceding posts for the backstory. If you don't have time, the gist is this was a recurrence of my original tumour from 2012 that came back 4 years later as a large hard lump. The lump was biopsied and confirmed as melanoma, and the margins of the WLE were large to try and mop up any stray cells.

7 days post-graft (usually the dressings aren't removed for 14 days but I was having issues with mine)

 

14 days post-graft

  

20 days post-graft

  

28 days post-graft

 

40 days post-graft

I don't have any more pictures because not long after this, it started to go pear-shaped. See next post :-(

The Operation Part II

"He drew around the wrong part of my leg."

Not what you want to realise when you come round from anaesthesia. Immediately followed by the horrific logic of "all this has been for nothing then".

Waiting for Dr S to come and do his rounds was awful. I was so angry I could have cried. Instead, I dozed. 

Finally, Dr S appeared and assured me the operation went well, blah blah blah. "Did it?" I asked. "Because I have realised that you drew around the wrong part of my leg. With smaller margins than you needed. And I didn't notice because I was so focused on the skin graft/local anaesthetic thing". He chose to totally ignore the angry undertones and brightly said "oh yes, Mr Khan spotted that and corrected it, don't worry". As though he had poured apple juice instead of orange. I never want to see that guy again. 

The following day was standard in hospital, with the only issue being my donor site not stopping bleeding. At 9am I asked for the dressing to be changed as it was soaked with blood, and by 2pm it still wasn't. I totally get how busy the ward nurses are and my blame lies firmly with Jeremy Hunt and the government for not providing enough money to the NHS for training and enough boots on the ground. Saturday evening I was discharged (with no dressings, which was a major problem as it would turn out) and home I went.

The following few days was spent in bed trying mostly to get comfortable. The back of my right leg was obviously cut wide open and skin grafted, although it wasn't as painful as it would sound because the nerves had been cut. The biggest pain by a long way, both literally and figuratively, was the donor site which was on the side of my left thigh. It WOULD NOT stop bleeding for days. We had been told under no circumstances to change the dressing so, like obedient school children, we didn't. Even when the blood soaked through to the other side and then my bedsheet. We called the district nurse instead and she came out and tried her best but didn't have a bandage big enough. Instead, she taped some padding to the gauze and put some smaller plasters over that, and then the pain began. Severe, scream-out-loud pain in the middle of the night. The next morning, Alex found the number for the dressings clinic at the hospital and called them. They were pretty disbelieving that we hadn't been giving any dressings nor their number but hey. We hadn't. They took the blood-soaked dressing off, which was rock-solid by that point, and redid it for me. They also decided to unstaple and re-dress the graft site and I was terrified they'd find the graft hadn't taken or some such nonsense but...it was fine. Alex took a photo and I didn't fully comprehend the size of the hole in my leg at that point. 10cm wide by 3cm deep. 

Photos to follow in the next post so skip it if you are squeamish.

The Operation Part I

It's hard to know where to begin writing this. I should probably start by saying I had my wide local excision and skin graft on 11th August so ~ spoiler alert ~ I survived!

On the day of the op, I arrived at my hospital bed to see an unfamiliar name down as my surgeon. I queried it and was told this consultant, let's call him Mr B, was the best of the best and that the consultant who was supposed to be performing the op, Mr K, was too busy with elective surgeries. I wasn't upset about this as Mr K specialised in breast and hand reconstruction. I'd only been put on his list because he was available and the two times I'd met him, he hadn't struck me as particularly knowledgeable about skin cancer.

A couple of hours go by, I go through all the usual forms, questionnaires, peeing in a cup etc etc. Then finally a man strides into my area and tells me he will be performing my op. As he is about to launch into his spiel, I stop him and ask "you're Mr B then, I presume?". "No", he says, "I am Mr S. I'm a junior doctor". Whut? "But you are a skin cancer specialist, right?" "I've dealt with it before, yes". I asked how a man clearly who isnt a specialist and who has never met me has ended up with my case, and it seems whoever isn't busy that day gets to do the op. Doesn't matter that they don't know you or have no knowledge of your case.

Except.

It does matter.

Because here is what happened.

He asked me if I wanted to be on my front or side. I said, puzzled, that I didn't care since I would be unconscious. He was very confused by that and said "no, you're having a local anaesthetic, aren't you?". "AM I FUCK" is what I wanted to say. "No, it's general" is what I actually said whilst my soul shrank. After he scanned my chart and decided I was correct, he asked for a cursory look at my leg and said "you don't need a skin graft". Have you ever spluttered? It's something you read in books. Characters splutter. Usually posh old men. I don't believe I have ever spluttered til that moment but I did because I was trying to get three different sentences out at once:

WHAT DO YOU MEAN?


THAT IS NOT WHAT I'VE BEEN TOLD BY TWO OTHER CONSULTANTS


ARE YOU FUCKING SHITTING ME?

It all came out as PFFWWWTFFF?

I did manage to ask him....something coherent, I guess...and objected enough that he had another look, asked me where the tumour was, I pointed, he drew a small oval incision line on my calf and said "I will decide when I get in there". At this point I could actually feel my pulse speeding up. My body reacting in fight or flight mode.

My friend Becca looked him up. His Linkd in photo is him in a bar with his mates. Are. You. Kidding. Me. Mr S, if you ever read this, you need to do better on SO MANY LEVELS.

Not long after, whilst I was still panicking, Mr K came onto the ward and I attracted his attention. I told him what Mr S had said, and thank god he assured me that I would be getting a skin graft as planned and that he himself would go into the theatre with me.

Now, you need to understand here I am not a glutton for punishment. I don't want a skin graft for the sake of it. I want it because it means they are removing a big amount of calf, and that means they are most likely getting rid of all the cancer. The histology had showed that I still had cancer left after my biopsy so I want it all gone and if two consultants say I need a graft, then I want a graft.

Not too long after, I go down for the op. Mr K is there, true to his word. We go through the questions that confirm ny identity without any doubt. They battle to find a vein as usual for the anaestheia, and I sign the last consent forms. Deep breath and under I went.

Some time later, I woke up and my very first thought was........shit. He drew his incision line around the wrong part of my leg...

Six Words

Six words you don't want to hear:

Donald Trump is the new President
The UK has voted for Brexit
The lump was a malignant melanoma

It's funny how sometimes you know things. When you've lived in your skin for 39 years, you know. Even when two consultants say "I think this is unlikely to be cancer". At the time that made me wonder if I was going crazy. I knew I wasn't and I knew a hard subcutaneous lump at the site of my original tumour could very definitely be a recurrence. But when two specialists tell you it's unlikely, you do doubt yourself.

That was just over a month ago and a lot has happened since then. When I have the energy and the time, I will log it all into some type of catalogue of errors. Or comedy of errors, if it all gets fixed and I get through it okay. Right now, I'm not laughing. Right now, I'm sitting in a hospital waiting room with a leg that has cancer in it.

I'll try to keep this lighthearted but you'll probably find the following entries are written in a bit of a different tone to those of five years ago. I'm older, wiser and less patient.

To be continued...