Posts Tagged open wound

Reader Request: Pressure Ulcer Surgery

Posted by admin in Dr D's Truth on December 12, 2012

“My mother has been paralyzed for many years and needed many surgeries. She has had a problem after a recent pressure ulcer surgery. The wounds have opened. Can you help her out? Her recent pressure wounds had been there for over a year and weren’t healing.”

Occasionally this blog connects me with potential patients who live locally in Orange County. I rarely meet this kind of person via the blog however and am not always able to help patients after recent surgery by another surgeon. With pressure ulcer surgery on large open wounds there are periods of opportunity during which surgery has the best potential. Right after an operation complicated by wound disruption, the wounds are frequently fragile and need to heal for a while before surgery can be performed successfully.

Pressure ulcer surgery is difficult in that it requires a protracted period of care after the operation itself. Medicare restricts how long a patient can be kept in an acute care hospital, so I do these cases in a long term acute environment (LTAC.) I specifically do the cases in an LTAC that I frequent. Other surgeons deal with these cases differently. Not many plastic surgeons spend much time doing decubitus ulcer surgery. These cases take time and are not infrequently complicated even when everything is optimal.

Pressure ulcer surgery is also best accomplished with a motivated patient who is ready and able to restrict pressure to the newly operated wound. Patients who sit on their newly-operated wounds shortly after surgery have poor success rates.

Best Regards,

John Di Saia MD

Related Posts:

Pressure Wound Surgery in Orange County

Originally posted 2011-11-09 07:30:11.

, , , , , ,

Comments

When You Really May Want A Plastic Surgeon For Skin Cancer….

Posted by admin in skin cancer on August 19, 2011

We discuss skin cancer and plastic surgery here intermittently – most recently here.

Large Basal Cell Skin Cancer Neck

Large Basal Cell Skin Cancer Neck

Here is a case in which the gentleman had a really large skin cancer behind his neck. He of course didn’t realize it was that large. His dermatologist sent him to me before she did the removal surgery to take the skin cancer out.

After she removed the skin cancer, she sent him to me with the hole you will see after the jump (if you would like.)  I operated on him the day after to perform a local flap to get this wound covered. These are not pretty cases. Many plastic surgeons avoid them as they believe that the results will impede their cosmetic practices. They may.

Obviously, this is not a cosmetic case although plastic surgery can make it look less objectionable that it would have in the hands of other specialists. If it were cosmetic, his health insurance wouldn’t have covered it. It did.

Best Regards,

John Di Saia MD

Originally posted 2009-12-31 07:30:12.

, , ,

Comments

Tumeric as a Wound Dressing?

Posted by admin in technical on July 28, 2011

This nice elderly Chinese gentleman with a hand wound became a patient. Like many Asian patients he uses some Eastern remedies in his daily life.

I have not seen the use of tumeric before for open wounds. This gentleman has been using it regularly for this hand wound as a dressing. He does not wish to have the wound treated with a skin graft. It is taking a while to heal and it is hard to tell if this is because of the tumeric, his age or use of the hand as he walks with a cane.

Some Eastern remedies seem to work pretty well. I am not sure this is one of them, but it is his hand.

Best Regards,

John Di Saia MD

Originally posted 2010-02-19 07:30:12.

, ,

Comments

Skin Cancer Wound Repair in the OC – Not So Pretty Plastic Surgery

Posted by admin in skin cancer on July 18, 2011

The removal of large skin cancers produces large holes. This patient had Mohs surgery by a dermatologist and appears with a hole in his face from that Mohs surgery. Many people do not know that Mohs surgery is specifically to remove the cancer and has nothing to do with the closure of the wound left afterward. When the problem gets large some patients (and some dermatologists as well) request plastic surgery. This case was operated via my South Orange County office in San Clemente.

Part of plastic surgery can be the repair of otherwise more disfiguring wounds. Sometimes plastic surgery is not cosmetic.

Best Regards,

John Di Saia MD

Originally posted 2007-12-15 15:12:00.

, , , , , ,

Comments

Dr Jan Adams Wound Healing Problem Case on TMZ

Posted by admin in plastic surgery complications on March 30, 2011

Source: tmz.com/2007/11/16/dr-adams-and-the-plastic-surgery-nightmare-the-pix

TMZ published images of another tummy tuck and breast lift/reduction patient of Dr Adams. She has the appearance of moderate to severe wound healing problems.

Although it is easy to just slam the good doctor here like everyone else, the fact is that these operations have risk. Although I would probably have done things differently I cannot know looking at a bunch of images if either technique or poor patient selection may have affected the outcome. Did the patient smoke? Cigarette smoking really puts a damper on healing from breast lift/reduction and tummy tuck surgery in particular. If the patient were a smoker, this kind of thing could have happened to any surgeon at least in the latest “images-included” case.

Best Regards,
John Di Saia MD

Originally posted 2007-11-16 21:34:00.

, , , ,

Comments

Vinnie Jones’ Nose Cut in Bar Fight

Posted by admin in celebrity plastic surgery on February 3, 2011

Former football hardman Vinnie Jones had his nose ‘cut down to the bone’ in a vicious bar-room brawl that erupted after he was taunted about being a tough guy. ‘We were having a laugh with a group of lads whose girlfriends I was doing pictures for. They started having a joke about my films. The next thing I knew I was on the ground with a glass in my face.’ ‘The blood was pouring out. The attack came from nowhere, I was stunned by it.’ ‘It was like a car crash, it all happened so quickly.’ The star of Lock, Stock And Two Smoking Barrels and X-Men revealed that he needed 48 stitches to his wounds.
Source: dailymail.co.uk/news/article-1092575/Someone-tried-blind–It-like-car-crash-Vinnie-Jones-relives-bar-room-brawl-left-48-stitches.html#ixzz1D61YqZ4H

Liquor is usually involved in bar fights. There is no mention as to whether plastic surgery was called to help repair the wound. Most emergency cases like these involve little or no payment, so most plastic surgeons stop doing them at some point in their careers.

Best Regards,

John Di Saia MD

Originally posted 2008-12-10 08:30:00.

, ,

Comments

Reader Question – Labiaplasty Opened Up! Help!

Posted by admin in labiaplasty on December 21, 2010

Reader Question:

I am not your patient but see that you do labiaplasty surgery. I wish I lived near you in Orange County. One side of my inner labia that was reduced a few weeks ago has come apart. I think a stitch broke or something. It hurts! My doc says just change the dressings and it will heal. Help! I am not sure I trust my surgeon. Tell me this will heal OK.

Labiaplasty surgery is done differently by different doctors. Some doctors have started doing them recently and do one layer repairs. Some do trim operations that just chop off the excess and baseball stitch it up. When done in such a manner problems are more frequent and the labia can look kinda tweaked when it has healed.

I do them differently (three layers, modified wedge, etc) but then again I have been doing them for a decade. Even with experience and care, occasionally things go wrong. Wounds can come apart and freak women out (understandably.) If the operation was done well, these openings are often small and heal without much problem in most cases. You need your surgeon’s input as this occurs. I recommend close follow-up meaning you see him or her in the office frequently. He or she should be instructing you as to how to care for the area.

Assuming you have found a competent surgeon, you are OK. Times like these test your original decision to make him or her your surgeon in the first place. Take care.

Best Regards,

John Di Saia MD

, , , , , ,

Comments

Miguel Torres Head Wound Closure

Posted by admin in Not Plastic Surgery on April 9, 2010

Miguel Torres is a fighter who got a burst injury to his forehead reportedly when elbowed. This was obviously not closed by a plastic surgeon:

Gruesome Picture Alert

The running suture closed under tension is the sign of a non plastic surgeon. That is going to scar.

Best Regards,

John Di Saia MD

,

Comments

Reader Question – Poor Wound Healing Mastectomy

Posted by admin in Picture Warning, plastic surgery complications on February 5, 2010

Dear Dr. I had a double mastectomy in mid December. I had tissue expanders and alloderm put in right away. My problem is I am not healing. I had surgery six weeks later to try to close the wounds again but here I am with open wounds again. You can see the alloderm. It is very painful also. I am so afraid because it has been so long. I see a regular surgeon and a plastic surgeon. Do you have any thoughts that might help! Please I am so afraid. Thank you so much.

After mastectomy breast reconstruction can be challenging. It is usually performed in multiple operations or Stages. In these cases the overall goals of surgery are to remove all the cancer but still leave enough tissue to allow for a good reconstruction. When tissue expanders are chosen for that reconstruction, the condition of the remaining tissue after the mastectomy is crucial to the success of the operation.

Your images (which I placed on the following page for those who may not want to look) show that soon after the mastectomy and tissue expander placement surgery skin necrosis appeared. When this develops it is concerning as it indicates that the wound may have the blood flow needed to heal. You show this problem on both sides.

At six weeks following your first operation, the skin necrosis started separating from the other tissues and the wound seemed to open on at least one side. Your surgeon at that point decided to go back to the operating room to try to remove this non healing tissue and salvage the reconstruction. In cases like these my concern is whether or not these wounds even if they are able to heal can do so without excessive scarring and hardening. Depending upon how things looked on examination, I would consider removing your expanders to allow the wounds to heal and the tissues to soften to allow reconstruction at a later date. This is a clinical judgment that your surgeon needs to make. He or she may have discussed something like this with you already.

Although I have not been involved in your care I am sorry you have had such difficulties and hope that things can be improved later down the line.

Best Regards,

John Di Saia MD

, , , ,

Comments

Mohs Surgery Makes Holes Plastic Surgeons Repair – Picture Alert

Posted by admin in Dr D's Patients, Picture Warning, skin cancer on December 1, 2009

Occasionally people ask about Mohs surgery. This is a type of surgery very common in Orange County performed mostly by dermatologists removing skin cancer. Its success is operator dependent and can result in large wounds as tissue is removed progressively in an attempt to remove a cancer entirely. People with large wounds particularly in sensitive areas like the tip of the nose may want a plastic surgeon involved to help minimize deformity. The patient you see here had a skin cancer on the tip of her nose that I repaired after her Mohs surgery.

This is the “After Plastic Surgery Repair” picture.

Plastic Surgery After Moh's Fixed The Wound - 1 Month Later

Plastic Surgery After Moh's Fixed The Wound - 1 Month Later

Page 2 will have the after Mohs surgery and “Before and After Plastic Surgery” pictures for you. The wound picture (after just the Mohs cancer removal) is not very pretty so skip this part if you prefer.

Best Regards,

John Di Saia MD

, , , , ,

Comments