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Resection of an Extremity Rhabdomyosarcoma

Rhabdomyosarcoma is the most common soft tissue sarcoma in childhood. The cause is unknown and it can occur in many different body sites. The extremities (arms and legs) account for about 18% of cases. If your child has been diagnosed with rhabdomyosarcoma in one of his/her extremities, surgery may be recommended to remove the tumor.

You and your child will come to the surgical clinic sometime in the week before surgery to meet with the surgeon and other members of the surgical team (such as nurses and an anesthesiologist) to ask and have questions answered. Your child will have some blood taken at this visit and may have other tests done if they are needed. All of the paperwork for surgery will be done at this visit so your child does not have to stay in the hospital the night before the surgery. If there are medications your child will need to take before surgery, or any s/he is on that need to be stopped, you will be told.

The anesthesiologist or nurse will give you specific guidelines as to what your child may eat, or NOT EAT, in the hours before surgery. You must follow these guidelines or the surgery may be cancelled.

You will bring your child to the pre-surgical area the morning of surgery. You may bring clothes for your child for after the surgery and any special items you think the child will want. Do not bring any valuables. You will be given a specific time to arrive at the hospital and should arrive no later than that time. After you arrive, the following will happen:

1. A nurse will ask you some questions and make sure the child has followed the diet guidelines. S/he will take your child’s temperature, blood pressure and heart rate.
2. A name band will be placed on the child’s wrist and you will be asked to change your child into a hospital gown. Any jewelry should be removed. 
3. An intravenous (IV) will be started in most cases and any preoperative medicines will be given.
4. You will wait with your child for someone from the operating room to come and escort you there.
5. You will be told where to wait while your child is in the operating room. Once the surgery is finished, you will be directed to the recovery room to be with your child. The surgeon will find you to tell you how the operation went.

Your child will be in the hospital for 3-7 days after the surgery. S/he will recover in a pediatric step down unit or a regular pediatric unit. The doctors and nurses will monitor your child’s pain, heart rate and blood pressure, check the dressing over the incision and the fingers or toes of that extremity. The dressing will be removed after 2 days and the incision will be checked by the surgical team. A new dressing may be put on or the incision may be left open. There will either be dissolving stitches, regular stitches or staples holding the incision together. If there are stitches or staples that need to be removed, the surgical service will do this about 7-10 days after the surgery.  Your child may have a drain in place to remove any fluid that might be in the area of the surgery. This is called a Jackson Pratt (JP) drain. This will be removed by the surgical service when the drainage decreases, usually after 3-5 days. 

Your child will be given pain medicine through the IV for the first few days after surgery and then we will switch medicine by mouth. S/he will be able to drink the night of the surgery and eat food if s/he is feeling well enough. The arm or leg will be elevated and immobilized for a few days. The doctor will tell the nurses when to start range of motion exercises. The incision needs to stay dry for 2-3 days. After that s/he will be able to shower. We do not want the incision under water for 2 weeks. If there are stitches or staples holding the wound together, ask the surgeon when your child may get the area wet.

Before going home, we will make sure your child is eating and drinking, having bowel movements, has well controlled or no more pain and that the incision is healing well. We will give you any instructions about caring for the wound at home. Any medications your child will need will be reviewed and you will be given prescriptions for them. If there are exercises for you to do with your child at home, or s/he will need some rehabilitation, we will give you those instructions. You will be given the surgeon’s phone number and emergency phone numbers. You will also be given an appointment to come back to the surgical clinic. Your child may return to school, but may not participate in gym class for 2 months. We will give you a note for that. It takes 6-8 weeks for the incision to heal fully. 

You should call the surgeon’s office if your child develops fever, swelling or significant new pain in the area of the surgery, redness or drainage from the incision or any other symptom that seem worrisome. 

Please reproduce and distribute this sheet to your surgery families. This material can also be downloaded at www.APSNA.org.

Copyright 2006, Laura San Miguel.  Copied with permission by Jones and Bartlett Publishers, Sudbury, MA."