Wednesday, September 29, 2010

Ears and things...

Where's your hat? Stay out of the sun! I can remember my mother's refrain from childhood. I was a very fair skinned kid and sunscreens were really not available when I was young. Consequently I was regularly burnt and on odd occasions I developed sunburn blisters - unpleasant and painful.
As I've got older I've become increasingly obsessive about sun protection - hats, screen, sunglasses, long sleeves...The problem of course is that the damage is done. All that childhood exposure is now revealing itself in the way of solar keratoses, and various bits and bumps. The dermatologist removes them or freezes them off and I go away for another 6 months.
About 12 months ago I became aware of an area on the face of my ear that developed a small crust and wouldn't heal. The dermatologist gave it a blast with liquid nitrogen but it reappeared. A biopsy revealed a Basal Cell Carcinoma (BCC). These things are slow growing but can be difficult to completely remove. I was referred to a plastic surgeon. He said "you'll be surprised how extensive this is". I wasn't! By now it had stretched from inside the antihelix across the face of the ear and up to very close to the ridge of the helix. The decision was that it had to be surgically removed and a full thickness skin graft used to cover the defect caused by the removal.
The ear in question with the graft in place - day 5

The surgery was scheduled as a day procedure. When the time came I was placed on my back on the operating table and the anaesthetist gave me a sedative and a short acting narcotic painkiller through a canula, whilst the surgeon infiltrated my ear with local. I was aware of what was going on but the drugs prevented me from feeling the pain as the local was injected and made me happy to just lie there.
The procedure involved removing the neoplastic tissue and a 2mm margin around it. Then a full thickness graft was harvested from the groove behind the same ear. I could feel the pressure of the cutting, snipping and pulling as the graft was harvested. Then the graft was trimmed for size and sutured in place with lots of interrupted sutures using nylon. I chatted briefly to the surgeon while the graft was sutured in place.
Once that was done the ear and surrounding hair were cleaned up, the drapes removed and then I shifted myself from the table to the trolley to go back to recovery and then after a couple of hours off home.
My ear was numb from the local. As that wore off later in the evening the pain began. Initially the pain was from the donor site for the graft. It was closed with dissolving sutures and because it was quite tight it was very painful. It was reasonably easy to control the pain with Nurofen (ibuprofen) and Panadeine Forte (paracetamol and codeine). However I required regular pain relief every 4 to 6 hours and sleeping was a real problem. I could only sleep on one side and moving hurt - it's amazing how and where your face and neck muscles are interconnected!
The surgery was latish on Friday afternoon. The weekend required regular painkillers but it wasn't too bad. However the pain got worse not better! I removed the dressing on Monday morning as directed and showered as normal before going off to work. My ear was swollen and sore with areas of numbness where nerves had been compromised. The graft looked like something out of a horror movie and there was some bruising and tenderness in various areas. Enough to frighten small children and squeamish adults!
Monday was a big day and I was glad to get home after work for a nap. The pain on Monday night was worse and I spent a fair part of the night awake as I waited for various doses of painkillers to kick in. Part of the pain seemed to be from the swelling and part from the increasingly tight sutures. Early on Tuesday morning the surgeon took the sutures out which was a bit of an ordeal and left me pale and sweating. He cleaned up the graft and declared himself happy. He put a vaseline gauze and a simple dressing in place for 24 hours. After that he directed a daily soak and cleaning of the graft with saline followed by a smear of petroleum jelly to keep the graft moist and supple. I'm to see him in 16 days.
I managed almost a full day at work on Tuesday, despite feeling shaky and looking pale, I had lots that needed doing - the surgery having coincided with a critical stage in a big project. Finally in the late afternoon I had to give in to the pain and go home. Tuesday night was bad from the point of view of pain control. I woke on Wednesday morning, after limited sleep, feeling pretty crappy. I finally gave in to the inevitable and took the day off work. I hope that will let me get on top of the cycle of pain and sleeplessness.
I'm left feeling that I cannot for the life of me understand why people would undergo this sort of pain for cosmetic reasons. In my case the BCC had to be removed before it spread further. However I can't understand why people have facelifts, boob jobs etc. It's just too painful!
Secondly all I can say is: if you are young then please take care of your skin. This kind of procedure is painful, costly and despite the skill of the surgeon, it will never look like it did before.

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