Skin cancer surgery with flaps and grafts

Introduction

Skin cancer is very common in Australia. There are several types of skin cancers. The most lethal is melanoma. The best hope for cure is early detection and treatment.

Indications

Skin cancers. Small skin cancers can be removed with primary closure, however, larger lesions may require closure with flap or a skin graft depending on size and the site of the skin cancer.

Pre-operative Instructions

Make sure you mark the site of the skin cancer, and confirm this with Dr. Daoud. Fast for the recommended time as advised by out clinic staff and / or the hospital.

General Risks

  • Small areas of the lungs may collapse, increasing the risk of a chest infection. This may need antibiotics and physiotherapy.
  • Clots in the legs (deep vein thrombosis or DVT) associated with pain and swelling. Rarely part of this clot may break off and go to the lungs (PE), which can be fatal.
  • A heart attack because of the strain on the heart of stroke.
  • Death is possible due to the procedure.

Post-operative Instructions

Pain

Post-operative pain is normal, but the intensity can differ individuals. Analgesia will be given to you during your hospital stay and made available to you on your discharge if still required. Please refer to the Medications section below.

Wound

The wound is to be kept clean and dry. The stitches are usually dissolvable but if not they will be removed in 7-10 days. A waterproof dressing will be applied to your wound before discharge. This is to be kept on for 7-10 days. If the dressings fall off before then you will need to have this re-dressed. Keep your wound dry and clean during this time to avoid infection.

Skin graft care

Please keep pressure dressings on till your review with Dr Daoud. The dressing must remain dry.

Swelling

Mild to moderate swelling is to be expected. This will continue to improve.

Diet

You will be able to drink 4 hours after your operation and have a light diet if you desire. A normal diet and fluid intake is usually started on the day following your operation.

Nasuea and vomiting

Some people are very sensitive to surgical procedures. Nausea and vomiting may occur as a result of the general anaesthesia, the procedure performed or the medications prescribed.

If you have nausea, please do the following:

  • Keep well hydrated with frequent small drinks of clear fluids. It is recommended that you drink water, lemonade or diluted fruit juice. Avoid milk.
  • Cease your medications, as in most cases the nausea and/or vomiting is related to the antibiotics prescribed. Once these have been ceased the nausea and/or vomiting will usually resolve.
  • Contact Dr Daoud’s office at Greenslopes if the nausea and/or vomiting persists.

Activities

24 hours after surgery you must not drive any motor-vehicle or operate machinery. You must not undertake any important new projects, make important decisions or sign legal documents. You must not drink any alcohol. Alcohol and prescribed medications is a dangerous mix. You should gradually return to normal activities. It is important to include walking in your daily routine and try to avoid standing still for long periods.

Medications

You will generally be prescribed antibiotics and analgesia. It is imperative that you notify Dr Daoud’s office of any allergies you have to any medication. If you are taking medication prescribed by your doctor, you need to return to your normal dosage schedule as soon as possible after surgery, unless directed otherwise. If you are having problems with bowel motions you may require an over-the-counter laxative preparation, such as Movicol.

Return to work / school

This will depend on the type of work you do. It is important not to be standing in one place for long period of time. It is usually 2-3 weeks before you may return to your normal work activities. If you require a medical certificate, please contact Dr Daoud’s office after your surgery and one will be arranged.

Infection

If you develop post-operative infection, remember it will not generally appear until 1-2 weeks after your operation. If this does occur, please contact Dr Daoud’s office to book an appointment. You will normally be prescribed a course of antibiotics after your surgery.

It is important that the full course of antibiotics is completed.

Post-operative review

You will need to contact Dr Daoud’s office when you are discharged from hospital, to make a post-operative review appointment for 2 weeks after surgery.

Problems

Post-operative complications are uncommon, but if they do occur please contact Dr Daoud’s office for advice.

Special issues of concern:

  • Increasing or persistent pain for 4-5 days.
  • Swelling around the wound site.
  • Redness or heat around the wound site.
  • Persistent nausea and / or vomiting.

Please do not call your referring doctor or local GP before you contact Dr Daoud’s office. Our office number is 07 3397 8499 and we are open from Monday to Friday 8:30am-5:00pm.

Risks/Complications

  • Fluid may build up under the wound (seroma), which may discharge through the suture line.
  • There may be scarring as part of the normal healing process.
  • The edges of the wound may not be in perfect alignment and may overlap. The body will correct this, but the resulting scar will vary between individuals.
  • The wound may heal and then stretch as time progresses.
  • The wound may heal with a thick raised scar, which may be discoloured and painful.
  • There is an increased risk for obese patients in developing wound and chest infections, heart and lung complications and thrombosis.
  • There is an increased risk for smokers to develop wound and chest infections, heart and lung complications and thrombosis.