74-year-old retired teacher Bill first had surgery to remove a tumour on his scalp 16 months ago but unfortunately the cancer has returned “This is all very subtle” said Bill “It broke out again a month ago and I saw Mr Saleh very quickly, within a couple of days.”
Bill had emergency surgery to remove the tumour and a temporary dressing was put in place to protect the wound. In the episode Bill has returned to the Royal Victoria Infirmary for the final reconstructive stage of his surgery performed by consultant plastic and reconstructive surgeon Dan Saleh.
Bill was raised on the east coast of Yorkshire and spent eight years teaching abroad and reflecting before surgery he believes the likely cause of his skin cancer is prolonged UV sun damage.
Although he’s worried about his wife – Bill has every faith in his surgeon “I have every confidence in Mr Saleh, you should only worry about things you can influence essentially what has to be done has to be done.” Luckily for Bill he has operating department orderly Allan to keep him company on his way to surgery.
In theatre 7 Dan maps out Bill’s surgery with colleagues outlining his plan. There’s one area where the tumour is quite close to the area of skin he’d previously removed so while the tumour has all been removed the margins are close so Dan will remove some further tissue to make sure all the cancer cells have been removed.
Dan explains: “We are being bold with this surgery but he will go on to have some radiotherapy most likely and then I will feel very comfortable when I see him in my clinic in five years’ time and he hasn’t had another problem in that time.”
Once the extra tissue is removed the reconstruction can begin which involves the team removing a perfectly sized flap of skin from Bill’s thigh. Dan’s biggest challenge is to match up the blood vessels in Bills scalp and the tissue taken from this thigh accurately.
Dan explains: “If you don’t have blood supply going in carrying oxygen and normal nutrients to the tissue to keep it alive it will start to die away and that serves no good purpose because he won’t get any healing.”
After delicate microscopic surgery, using sutures like the thickness of the hair, the vessels are attached and stitching can begin. After 70 meticulous stitches Bill’s surgery is complete and now comes the moment of truth.
Dan carries out a critical test to check the tissue has the essential blood supply it needs – “lovely, good signal from that doppler – that went as well as we could hope.”
Following surgery Bill made a good recover and is now back home and enjoying country walks.
