Skin Graft Question

They did a PET and are removing lymph nodes for this thin a lesion?

They did a PET and are removing lymph nodes for this thin a lesion?

They did a PET and are removing lymph nodes for this thin a lesion?

Hi Robert, so sorry you are going through this. Your situation is not minor – no need to apologize.

   In my husband's case no choice was given – and honestly, I don't know which kind was done. I assumed it was a full skin graft, not knowing that a half-thickness was possible. Perhaps it wouldn't work on the top of the head, where my husband's melanoma was removed.

   It is normal to do the sentinel lymph node biopsy (SLNB)  at the same time that the wide local excision (WLE) is done – they will most likely first inject dye at the site of the melanoma lesion and the radologist will follow it on the xray machine to see which lymph node(s) it goes to first. Then you will go to surgery, and the oncological surgeon will take out the lymph nodes that "lit up" during the radiology study and send them for biopsy. Following that, the plastic surgeon will remove the lesion, plus a wide margin, and send the removed tissue to a dermatopathologist for biopsy. The tissue from your abdomen will be used to cover the area where the melanoma and margins are removed.

  I suggest that you ask the plastic surgeon what the ramifications of each choice would be, and then also ask which he or she would recommend. Which would likely heal more completely and allow you to walk more normally? Would the healing time be the same? What would the wound care entail? Would the graft-donor site heal more easily, one way or the other?

   Please let us know what the surgeon says and what you decide. We'll be thinking of you.

Hazel

Hi Robert, so sorry you are going through this. Your situation is not minor – no need to apologize.

   In my husband's case no choice was given – and honestly, I don't know which kind was done. I assumed it was a full skin graft, not knowing that a half-thickness was possible. Perhaps it wouldn't work on the top of the head, where my husband's melanoma was removed.

   It is normal to do the sentinel lymph node biopsy (SLNB)  at the same time that the wide local excision (WLE) is done – they will most likely first inject dye at the site of the melanoma lesion and the radologist will follow it on the xray machine to see which lymph node(s) it goes to first. Then you will go to surgery, and the oncological surgeon will take out the lymph nodes that "lit up" during the radiology study and send them for biopsy. Following that, the plastic surgeon will remove the lesion, plus a wide margin, and send the removed tissue to a dermatopathologist for biopsy. The tissue from your abdomen will be used to cover the area where the melanoma and margins are removed.

  I suggest that you ask the plastic surgeon what the ramifications of each choice would be, and then also ask which he or she would recommend. Which would likely heal more completely and allow you to walk more normally? Would the healing time be the same? What would the wound care entail? Would the graft-donor site heal more easily, one way or the other?

   Please let us know what the surgeon says and what you decide. We'll be thinking of you.

Hazel

Hi Robert, so sorry you are going through this. Your situation is not minor – no need to apologize.

   In my husband's case no choice was given – and honestly, I don't know which kind was done. I assumed it was a full skin graft, not knowing that a half-thickness was possible. Perhaps it wouldn't work on the top of the head, where my husband's melanoma was removed.

   It is normal to do the sentinel lymph node biopsy (SLNB)  at the same time that the wide local excision (WLE) is done – they will most likely first inject dye at the site of the melanoma lesion and the radologist will follow it on the xray machine to see which lymph node(s) it goes to first. Then you will go to surgery, and the oncological surgeon will take out the lymph nodes that "lit up" during the radiology study and send them for biopsy. Following that, the plastic surgeon will remove the lesion, plus a wide margin, and send the removed tissue to a dermatopathologist for biopsy. The tissue from your abdomen will be used to cover the area where the melanoma and margins are removed.

  I suggest that you ask the plastic surgeon what the ramifications of each choice would be, and then also ask which he or she would recommend. Which would likely heal more completely and allow you to walk more normally? Would the healing time be the same? What would the wound care entail? Would the graft-donor site heal more easily, one way or the other?

   Please let us know what the surgeon says and what you decide. We'll be thinking of you.

Hazel

Hello Robert,

I had a split thickness skin graft done on the top of my right foot in February 2013.  See my profile for details.  I don't recall being actually offered a full thickness or split thickness graft option however I later read in the surgical notes that a full thickness graft was intially planned but it was determined that a split thickness graft would be better tolerated and appropriate for the wound.

I actually had to wait for my intitial WLE pathology to come back clean before they did the graft which was about 4 weeks after my initial surgery.  I can tell you that for me the split thickness graft has had a lot of contraction, basically it continues to shrink and pull my three center toes up off the ground.  It's a contant effort to stretch the skin and keep it somewhat plyable.  The grafted skin reminds me of a leather belt in regards to how much flex or lack of flex the skin has.  The skin bends but not very much and really doens't stretch at all.  The split thickness grafted skin also has very little if any feeling in it. The edges of the graft site have "super" sensitivity but the actual skin has no sensation.  I can feel pressure but not any sort of touch or pain on the skin section itself.

I know that with the full thickness graft they harvest all layers of the skin and then stitch it up whereas the split thickness consists of basically shaving a large section of skin off which left me with a pretty inflamed and scarred patch of thigh skin.  The plastic surgeon told me several months after surgery that my donor site didn't heal properly so that explains the appearance of my thigh.  It doens't hurt anymore, just ugly.

I don't know if this gives you any helpful insight but I wish you well and can tell you that getting back to walking on your foot will be a real challenge but don't give up.  You'll be surprised with regular and sometimes very painful effort before you know it you be back to walking in no time.  Shoes on the other hand?  Well you may want to purchase some oversized slippers with a sturdy sole.  Slippers for me "were" my shoes for several months.  I also suggest a walker over crutches.  Yeah, you'll feel like your 100 years old but with a walker to can attach a bag to it and bring things with you.  Using crutches and carrying stuff was just too much for me.

Good luck with your surgery and here's hoping that all your pathology comes back clear and you don't look back.

Hello Robert,

I had a split thickness skin graft done on the top of my right foot in February 2013.  See my profile for details.  I don't recall being actually offered a full thickness or split thickness graft option however I later read in the surgical notes that a full thickness graft was intially planned but it was determined that a split thickness graft would be better tolerated and appropriate for the wound.

I actually had to wait for my intitial WLE pathology to come back clean before they did the graft which was about 4 weeks after my initial surgery.  I can tell you that for me the split thickness graft has had a lot of contraction, basically it continues to shrink and pull my three center toes up off the ground.  It's a contant effort to stretch the skin and keep it somewhat plyable.  The grafted skin reminds me of a leather belt in regards to how much flex or lack of flex the skin has.  The skin bends but not very much and really doens't stretch at all.  The split thickness grafted skin also has very little if any feeling in it. The edges of the graft site have "super" sensitivity but the actual skin has no sensation.  I can feel pressure but not any sort of touch or pain on the skin section itself.

I know that with the full thickness graft they harvest all layers of the skin and then stitch it up whereas the split thickness consists of basically shaving a large section of skin off which left me with a pretty inflamed and scarred patch of thigh skin.  The plastic surgeon told me several months after surgery that my donor site didn't heal properly so that explains the appearance of my thigh.  It doens't hurt anymore, just ugly.

I don't know if this gives you any helpful insight but I wish you well and can tell you that getting back to walking on your foot will be a real challenge but don't give up.  You'll be surprised with regular and sometimes very painful effort before you know it you be back to walking in no time.  Shoes on the other hand?  Well you may want to purchase some oversized slippers with a sturdy sole.  Slippers for me "were" my shoes for several months.  I also suggest a walker over crutches.  Yeah, you'll feel like your 100 years old but with a walker to can attach a bag to it and bring things with you.  Using crutches and carrying stuff was just too much for me.

Good luck with your surgery and here's hoping that all your pathology comes back clear and you don't look back.

Hello Robert,

I had a split thickness skin graft done on the top of my right foot in February 2013.  See my profile for details.  I don't recall being actually offered a full thickness or split thickness graft option however I later read in the surgical notes that a full thickness graft was intially planned but it was determined that a split thickness graft would be better tolerated and appropriate for the wound.

I actually had to wait for my intitial WLE pathology to come back clean before they did the graft which was about 4 weeks after my initial surgery.  I can tell you that for me the split thickness graft has had a lot of contraction, basically it continues to shrink and pull my three center toes up off the ground.  It's a contant effort to stretch the skin and keep it somewhat plyable.  The grafted skin reminds me of a leather belt in regards to how much flex or lack of flex the skin has.  The skin bends but not very much and really doens't stretch at all.  The split thickness grafted skin also has very little if any feeling in it. The edges of the graft site have "super" sensitivity but the actual skin has no sensation.  I can feel pressure but not any sort of touch or pain on the skin section itself.

I know that with the full thickness graft they harvest all layers of the skin and then stitch it up whereas the split thickness consists of basically shaving a large section of skin off which left me with a pretty inflamed and scarred patch of thigh skin.  The plastic surgeon told me several months after surgery that my donor site didn't heal properly so that explains the appearance of my thigh.  It doens't hurt anymore, just ugly.

I don't know if this gives you any helpful insight but I wish you well and can tell you that getting back to walking on your foot will be a real challenge but don't give up.  You'll be surprised with regular and sometimes very painful effort before you know it you be back to walking in no time.  Shoes on the other hand?  Well you may want to purchase some oversized slippers with a sturdy sole.  Slippers for me "were" my shoes for several months.  I also suggest a walker over crutches.  Yeah, you'll feel like your 100 years old but with a walker to can attach a bag to it and bring things with you.  Using crutches and carrying stuff was just too much for me.

Good luck with your surgery and here's hoping that all your pathology comes back clear and you don't look back.

Hi Robert,

No need to appologize!  This is a big deal.

I had a split skin graft and didn't have any problems with it.  The graft went around my pinkie knuckle and on to the side of my hand.  It was gross for awhile, but to be honest after it was healed and I had PT to regain the use of 2 fingers, I didn't have any problems with it.  I'm grateful that even though it's in an awkward spot (knuckles and side of hand) I have no problems.

The Dr took the graft skin from my outer thigh and while it hurt the first day and when the bandage was changed, it pretty much didn't hurt any other time.  I've been told that the secret to it not hurting is to keep it covered with a Tegraderm type (clear plastic put on once and leave on for 3-4 day) plaster.  But I could be wrong.  

Peace,

Julie

Hi Robert,

No need to appologize!  This is a big deal.

I had a split skin graft and didn't have any problems with it.  The graft went around my pinkie knuckle and on to the side of my hand.  It was gross for awhile, but to be honest after it was healed and I had PT to regain the use of 2 fingers, I didn't have any problems with it.  I'm grateful that even though it's in an awkward spot (knuckles and side of hand) I have no problems.

The Dr took the graft skin from my outer thigh and while it hurt the first day and when the bandage was changed, it pretty much didn't hurt any other time.  I've been told that the secret to it not hurting is to keep it covered with a Tegraderm type (clear plastic put on once and leave on for 3-4 day) plaster.  But I could be wrong.  

Peace,

Julie

Hi Robert,

No need to appologize!  This is a big deal.

I had a split skin graft and didn't have any problems with it.  The graft went around my pinkie knuckle and on to the side of my hand.  It was gross for awhile, but to be honest after it was healed and I had PT to regain the use of 2 fingers, I didn't have any problems with it.  I'm grateful that even though it's in an awkward spot (knuckles and side of hand) I have no problems.

The Dr took the graft skin from my outer thigh and while it hurt the first day and when the bandage was changed, it pretty much didn't hurt any other time.  I've been told that the secret to it not hurting is to keep it covered with a Tegraderm type (clear plastic put on once and leave on for 3-4 day) plaster.  But I could be wrong.  

Peace,

Julie

Hi Robert,

I had a full thickness graft on my heel in 2010 for a stage 2A acral lentiginous melanoma. I could not be happier with my result and I now can do everything I want with my affected foot. There is a significant scar, but it is really not that noticeable. I have been to the beach many times since my surgeries and no one even notices it.

My graft is about 2 inches x 3 inches, making up about 1/3 of the heel and wrapping up the side of the foot. It is very soft and flexible, except for the edges which are a little stiff. It required a separate microsurgery procedure after my WLE procedure, which was closed with a temporary cadaver graft. My plastic surgeon would't do the microsurgical procedure until the WLE pathology came back as having clean margins.

In the microsurgical procedure, a flap of skin shaped like a football was removed from my thigh and then grafted onto my foot. The veins were sewn into my leg's blood supply, which required a week stay in the hospital while the blood flow was monitored hourly with special equipment by the nurses. I also had a two week period of elevating the foot to give the graft a chance to heal before I could begin to lower the foot to the floor. I was in a wheel chair those first 2 weeks with the affected foot elevated, and then another 2 weeks in which I could put my foot on the floor, but only for brief (but increasingly longer) time periods. This was following what is called a "dangling protocol." it was pretty tough to cope with, but the results were amazing. The graft was a little oversized, which my doctor told me was intentional because it is unpredictable how much the graft will shrink in size upon healing, and it also helps to accommodate the initial swelling without tearing the countless stitches.

The toughest part of the entire treatment was in being in the wheelchair for a month and then on cruches for 2 weeks after that and beginning to walk again after not walking for over a month. But I was a very active and young person and I was determined to get back to doing everything I used to do and pushed myself very hard with the physical therapy and weightlifting as soon as I was allowed. After a year I went back for a final procedure to reduce the size of the graft in another surgical procedure. This was an outpatient procedure but required another 2 weeks on crutches.

I would do it again if faced with the option because the key benefit of a full thickness skin graft is that there is a lot of padding that comes with the skin in the form of subcutaneous tissue and fat, which is essential for the sole of the foot. I thought I would have issues with walking on my graft because it is leg skin…not the thick, calloused skin normally on the sole of the foot, but I really have never had an issue in over 3 years. I will say that the graft is not as dense and solid as my native sole, but it is quite functional.

I hope this helps you make your decision. I was initially told I was going to get a split thickness graft, but then my doctor changed his mind and strongly recommended the full thickness graft. I believe his reasoning had to do with the extra thickness that this type of graft affords. I have to say he was right…except for the scar you would never know anything was ever wrong with my foot. 

Best of luck to you.

Mark from California

Hi Robert,

I had a full thickness graft on my heel in 2010 for a stage 2A acral lentiginous melanoma. I could not be happier with my result and I now can do everything I want with my affected foot. There is a significant scar, but it is really not that noticeable. I have been to the beach many times since my surgeries and no one even notices it.

My graft is about 2 inches x 3 inches, making up about 1/3 of the heel and wrapping up the side of the foot. It is very soft and flexible, except for the edges which are a little stiff. It required a separate microsurgery procedure after my WLE procedure, which was closed with a temporary cadaver graft. My plastic surgeon would't do the microsurgical procedure until the WLE pathology came back as having clean margins.

In the microsurgical procedure, a flap of skin shaped like a football was removed from my thigh and then grafted onto my foot. The veins were sewn into my leg's blood supply, which required a week stay in the hospital while the blood flow was monitored hourly with special equipment by the nurses. I also had a two week period of elevating the foot to give the graft a chance to heal before I could begin to lower the foot to the floor. I was in a wheel chair those first 2 weeks with the affected foot elevated, and then another 2 weeks in which I could put my foot on the floor, but only for brief (but increasingly longer) time periods. This was following what is called a "dangling protocol." it was pretty tough to cope with, but the results were amazing. The graft was a little oversized, which my doctor told me was intentional because it is unpredictable how much the graft will shrink in size upon healing, and it also helps to accommodate the initial swelling without tearing the countless stitches.

The toughest part of the entire treatment was in being in the wheelchair for a month and then on cruches for 2 weeks after that and beginning to walk again after not walking for over a month. But I was a very active and young person and I was determined to get back to doing everything I used to do and pushed myself very hard with the physical therapy and weightlifting as soon as I was allowed. After a year I went back for a final procedure to reduce the size of the graft in another surgical procedure. This was an outpatient procedure but required another 2 weeks on crutches.

I would do it again if faced with the option because the key benefit of a full thickness skin graft is that there is a lot of padding that comes with the skin in the form of subcutaneous tissue and fat, which is essential for the sole of the foot. I thought I would have issues with walking on my graft because it is leg skin…not the thick, calloused skin normally on the sole of the foot, but I really have never had an issue in over 3 years. I will say that the graft is not as dense and solid as my native sole, but it is quite functional.

I hope this helps you make your decision. I was initially told I was going to get a split thickness graft, but then my doctor changed his mind and strongly recommended the full thickness graft. I believe his reasoning had to do with the extra thickness that this type of graft affords. I have to say he was right…except for the scar you would never know anything was ever wrong with my foot. 

Best of luck to you.

Mark from California

Hi Robert,

I had a full thickness graft on my heel in 2010 for a stage 2A acral lentiginous melanoma. I could not be happier with my result and I now can do everything I want with my affected foot. There is a significant scar, but it is really not that noticeable. I have been to the beach many times since my surgeries and no one even notices it.

My graft is about 2 inches x 3 inches, making up about 1/3 of the heel and wrapping up the side of the foot. It is very soft and flexible, except for the edges which are a little stiff. It required a separate microsurgery procedure after my WLE procedure, which was closed with a temporary cadaver graft. My plastic surgeon would't do the microsurgical procedure until the WLE pathology came back as having clean margins.

In the microsurgical procedure, a flap of skin shaped like a football was removed from my thigh and then grafted onto my foot. The veins were sewn into my leg's blood supply, which required a week stay in the hospital while the blood flow was monitored hourly with special equipment by the nurses. I also had a two week period of elevating the foot to give the graft a chance to heal before I could begin to lower the foot to the floor. I was in a wheel chair those first 2 weeks with the affected foot elevated, and then another 2 weeks in which I could put my foot on the floor, but only for brief (but increasingly longer) time periods. This was following what is called a "dangling protocol." it was pretty tough to cope with, but the results were amazing. The graft was a little oversized, which my doctor told me was intentional because it is unpredictable how much the graft will shrink in size upon healing, and it also helps to accommodate the initial swelling without tearing the countless stitches.

The toughest part of the entire treatment was in being in the wheelchair for a month and then on cruches for 2 weeks after that and beginning to walk again after not walking for over a month. But I was a very active and young person and I was determined to get back to doing everything I used to do and pushed myself very hard with the physical therapy and weightlifting as soon as I was allowed. After a year I went back for a final procedure to reduce the size of the graft in another surgical procedure. This was an outpatient procedure but required another 2 weeks on crutches.

I would do it again if faced with the option because the key benefit of a full thickness skin graft is that there is a lot of padding that comes with the skin in the form of subcutaneous tissue and fat, which is essential for the sole of the foot. I thought I would have issues with walking on my graft because it is leg skin…not the thick, calloused skin normally on the sole of the foot, but I really have never had an issue in over 3 years. I will say that the graft is not as dense and solid as my native sole, but it is quite functional.

I hope this helps you make your decision. I was initially told I was going to get a split thickness graft, but then my doctor changed his mind and strongly recommended the full thickness graft. I believe his reasoning had to do with the extra thickness that this type of graft affords. I have to say he was right…except for the scar you would never know anything was ever wrong with my foot. 

Best of luck to you.

Mark from California