Wednesday, January 22, 2014

Nevus Removal Surgery Day

Day of the giant hairy nevus excision at OSF Saint Francis Hospital, Children's Hospital of Illinois.
Surgery time is 8am so we checked in at 6am.  Everything went smoothly.  Of course "C" got hungry, but between the toy room, riding in the kid car and blowing bubbles the wait was a snap.  At about 7:45 we handed "C" off to the surgical assistant Cassie who took him with his favorite stuffed animal "Dog" back to the OR.  At this moment Jamie and I had the classic knot in the stomach, but because the wait had gone so smoothly and we'd been in this situation before the anxiety was less.




The procedure:  the mole was 11 cm from front to back and about that top to bottom.  It included hair growing tissue as well as non-hair growing, a bit of eye-brow and tiny bit of eye-lid.  The surgeon was able to remove the entire mole plus 2mm around the perimeter that also contained melanocytic cells that were invisible to the eye.  The mole was excised.  The rear expander was deflated and scalp stretched forward to reconstruct the hairline.   The expander in the forehead was removed, tissue pulled toward the scalp and a piece of expanded tissue was removed.  The stitches in the forehead cut are in the hairline.  The severed tissue was then grafted to the side of the forehead where the mole was removed.  Doing it this way avoided puckering of the skin and additional scars in the forehead that would have resulted from turning the extra tissue instead of grafting it.  The yellow gauze is stitched to the surrounding skin to put downward pressure on the graft to avoid sub-dermal clotting and funny stuff thereby allowing it to get established.  Long term C will be missing about 1cm of eye-brow.  A small sacrifice. 
Without
With Nevus










The wait during surgery is always hard.  We were packed with enough snacks and word finds for a week, can never have enough.  After 3 hours and 15 minutes we were notified that the surgery was over and we met with Dr Elwood.  Dr. Elwood explained that the surgery had gone very well.  He drew out the incisions on a dry erase board and explained what tissue had been moved where.  It was interesting to hear the doctor's thought process, get a glimpse of what plan A was, contingencies, and reflection on what other surgeons have done with various outcomes.  Even having talked multiple times with the surgeon I went into the day with a self-fabricated expectation of the process and outcome.  Because I am not a plastic surgeon my fabrication was a bit off...    At this point we felt a lot of relief knowing it was over and had gone well.  It's a whole different anxiety wanting to get in and be with him to help through recovery, the physical reassurance.

One visitor is allowed in the preliminary recovery room and one person is allowed to spend the night.  We split up the one-person duties, Jamie spent the night and Erik saw C first.  I was taken into the recovery room.  From a distance I could see him crying and upset, demanding "Dog".  He had not seen me and when I arrived at his side the crying changed to "da, da,da" and reaching toward me he sat up abruptly.  I have been in this situation 3 times now and even though I knew that everything went well, with relief that the whole thing is over and the kid is going to thrive, I got the lump in my throat and a pang of guilt.  Pain management is not fun.  So C was moved from the bed to my lap, he stopped crying and seeped a little blood on me (signs of love and affection).  He drank voraciously from the Thomas sippy cup I brought along and then refused to let go of it for the next 3 hours.  After 30 minutes we were moved out of recovery to another room for overnight monitoring.

C was reunited with Mom!  Dad was now chopped liver.  He had some morphine and took a nice long nap on Jamie.  It was wonderful!  Recovery continued to go well.  C ate oatmeal and some banana that night.  A good sign of recovery from anesthesia.  No vomiting at all.  

The IV and monitoring instruments came off in the morning and C was discharged at about 9am Thursday.   Our first nurse's son had a skin graft done by the same surgeon, a good bonding experience.  Erik and the kids picked Jamie and C up from OSF at about 9:30 to head back to the house.  Yay!    


   
 

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