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Wide Local Excision of Melanoma

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  • Biopsy-proven cutaneous melanoma.

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Inguinal Lymph Node Dissection

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  • Documented metastatic disease in the inguinal lymph nodes with no evidence of distant metastases.
  • Metastases detected in the inguinal nodes by sentinel lymph node (SLN) biopsy or by fine needle aspiration or excisional biopsy in a patient with a clinically evident lymph node metastasis.

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Full-Thickness Skin Graft

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  • Coverage of large defects created by wide local excision of a melanoma that cannot be closed primarily or with a local flap.

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Absolute

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  • Inability to close donor site incision.

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Relative

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  • Concern about incomplete resection (positive margins).
  • Poor wound conditions (poor vascularization, exposed bone, open joint surfaces).

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Wide Local Excision of Melanoma

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  • Patient position depends on the location of the melanoma to be excised.
  • Patients may need to be supine, prone, or in lateral decubitus position.

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Inguinal Lymph Node Dissection

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  • The patient should be supine with the leg slightly flexed at the knee and externally rotated (frog leg position).
  • A Foley catheter is placed.
  • The abdominal wall, inguinal region, and proximal thigh are prepped and draped into the surgical field.

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Full-Thickness Skin Graft

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  • Patient position depends on the location of the defect to be covered and the donor site.

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Wide Local Excision of Melanoma

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  • Routine wound care.
  • Removal of any external sutures at an interval of 7–14 days postoperatively, depending on wound tension and location (eg, shorter interval for facial sutures).
  • Patients should protect the surgical site from excessive sun exposure during the first year to prevent darkening of the scar.

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Inguinal Lymph Node Dissection

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  • Patients are admitted overnight with the Foley catheter left in place and the leg elevated.
  • Antibiotics are maintained for 24 hours postoperatively.
  • Patients may be discharged the next day.
  • If the sartorius was transposed, we prefer to send the patient home with crutches and toe-touch weight bearing only.
  • Patients are encouraged to wear compression stockings as soon as possible to minimize lymphedema.
  • The drain to bulb suction is continued until output is < 30 mL per 24 hours for 2 consecutive days.
    • The drain should not remain in place longer than 3–4 weeks.
    • It may be better to accept a lymphocele than a wound infection.
  • Sutures are removed after 10–14 days.
  • Patients are followed closely for infection or other wound complications.

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Full-Thickness Skin Graft

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  • Routine wound care for the donor or SLN biopsy site.
  • The bolster is removed approximately 5 days after placement (sooner if there is evidence of bleeding or infection). For a tie-over bolster, after the silk sutures are cut, the bolster is moistened and carefully removed to avoid lifting the graft off the underlying wound bed.
  • A ...

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