Return to: Melanoma (Evaluation and Management)

See also: Case Example Full Thickness Skin Graft (subsequent reconstruction with full thickness skin graft with long term f/u)

Case Example

General anesthesia was induced and he was intubated with the tube secured in left oral commissure. The table was turned 180 degrees. His head of bed was elevated. 2 cc of plain 1:100,000 epinephrine (no lidocaine) was injected into his right temple region. Following this, the patient was prepped and draped in a sterile fashion with ground pad for Parsons McCabe facial nerve stimulator placed.

An elliptical incision was marked surrounding the previous scar to widely encompass with 1 cm + margins about the central portion of the scar - yielding a margin was 1 cm laterally and 0.5 cm medially close to his eye. After this margin was marked, the 15 blade was used to make an incision through the dermis. Careful dissection from a lateral to medial approach permitted identification of the frontal branch of the facial nerve employing the Parsons-McCabe facial nerves stimulator. Dissection was performed in a plane lateral to the nerve and the fascia of the orbicularis oculi. The excision was measured at 3.5 x 2.5 cm. Hemostasis was achieved with pressure. There was no cautery that was used. Following this, the porcine graft was measured and was sutured into the area with 5-0 chromic. The bolster was then applied after placing bacitracin opthalmic ointment over the porcine graft, then one layer of Adaptic, then 2 layers of Telfa. The dressing was then sutured with 5-0 Prolene circumferentially in simple interrupted fashion.