The short version

Diagnosis
Malignant Melanoma (Soft Tissue Sarcoma in sole of left foot)
Decubitus Trochanter major left hip.
Procedure
Resection of tumour site and sentinel lymph node and reconstruction by means of a M. latissimus dorsi flap on 23.05.01
Removal of artificial skin (Epigard) and secondary suture of left foot on 01.06.01.
Excision of decubitus and secondary suture under LA on 08.06.01
Analysis
Tumour-free remains of the sole of the foot with resorptive infection, tumour-free sentinel lymph nodes. Malignant Melanoma (Soft Tissue Sarcoma). Stage pT1a (diameter 2.5cm), N0, Mx, R0.
History
Pressure-related pain due on the ball of the left foot; at the same time noticed a swelling in the same area. Since then slow increase in pain. Resection of tumour (plantar fibromatosis). In histological analysis evidence of a malignant melanoma. No metastases or primary tumour could be found. Resection of site of tumour, with subsequent graft of a latissimus dorsi flap, plus sentinel node removal on 23.05.01.
Further
Post-op procedure with well-healed scar. Mobilisation in wheelchair with support for the operated leg. Removal of artificial skin (Epigard) and secondary suture of left foot on 01.06.01. After good blood flow in flap, start with flap training. Excision and secondary suture of decubitus over the left trochanter major on 08.06.01. After evident of Staph. aureus in the superficial decubitus swipe, antibiotherapy with Cefuroxim 500 1-0-1. Released on 11.06.01.

Physiotherapy. Regular check of scar and change of dressing. Flap training. After the 6th week, made to measure compression stocking and Allgöwer (ankle/foot) brace. Weight on foot after 12 weeks at the earliest, in steps from 20kg with an orthopaedic shoe. Thinning out of the flap after 6 months at the earliest.


  The very short version

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