Posts Tagged skin graft

Ugly Plastic Surgery – Thigh Wound Skin Grafts

From my Instagram here is a series of images of a man’s thigh with wounds from drug abuse and infection over years.

“Skin popping” refers to the practice amongst drug users of “popping” the skin with needles filled with their drug of choice. The needles these people use are often not very clean and result in skin infections and at times open wounds. This man’s legs show years of wounds with poor quality healing resulting in scarring (white spots) mixed with newer open wounds from more recent injury.

Two wounds on the pictured leg were cleaned surgically (debridement) and grafted with shavings of the patient’s skin. In one image the grafts appear covered with foam dressings (stents) awaiting adherence before stent removal. The third image is of the newly adherent and healing grafts. Without graft surgery these wounds would have taken months if cared for properly under ideal conditions to heal. This is not pretty cosmetic plastic surgery, but is rather a needed and underpaid aspect of plastics that fewer and fewer plastic surgeons practice.

Best Regards,

John Di Saia MD

Originally posted 2012-08-17 07:30:12.

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Good (but Ugly) Plastic Surgery in the OC – Good Skin Graft


“Not all plastic surgery is cosmetic surgery, but cosmetic surgery pays the bills.”
This is a plastic surgery truism. There are plastic surgeons (like me!) who split their work between the things you need (that don’t pay your surgeon so well) and the things you want (that do.) In this sense cosmetic surgery is the subsidy upon which the needed (but less well reimbursed) work is supported.

Here is an ugly plastic surgery case of an ankle wound that needed some skin to close. The patient had had an operation by an orthopedist that got complicated. The skin graft surgery will leave a scar, but the wound that would have healed slowly if at all without it healed quickly afterward. This is an aspect of good plastic surgery rarely featured on your local news program.

Something to think about when you are considering cosmetic plastic surgery:

If you support a reconstructive plastic surgeon, he may be able to stay in business to be able to help you when you might need him. That cosmetic guy won’t be.

Best Regards,

John Di Saia MD

Originally posted 2012-10-10 07:30:20.

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Thankless Plastic Surgery – Surgery For a Drug Abuser’s Wounds

Despite the fact that many online portray plastic surgeons as thoughtless purveyors of less than necessary cosmetic surgery, there are medically related plastic surgery procedures. There are surgeons like myself who perform a balance of these medically related operations as well as cosmetic surgery. Finally there are good reasons why many other plastic surgeons limit their practices solely to cosmetic work.

This week in trying to perform a skin grafting procedure to close the wound on a drug abuser’s shoulder, I was reminded of these limiting reasons. Caring for this frequently difficult patient population is a chore. Much of this chore is uncompensated and the surgery doesn’t pay that well either.

Recently our unnamed patient was admitted to a Long Term Acute Hospital at which I care for wounded patients. I had cared for him there before operating for and successfully closing another drug related wound in his other arm. He returned asking for a newer wound to be similarly addressed.

“Drug Abuse” patients frequently try the patience of those caring for them. They also test reasonable limits of operation of the facilities in which they stay. During this patient’s stay, he on multiple occasions left the hospital for hours at a time. Despite this he was scheduled for surgery on two adjoining days only to have that surgery cancelled when he refused to refrain from eating prior to surgery to properly prepare for anesthesia.

When the patient’s willingness to comply with procedure was noted as obviously substandard, it was decided to not offer him additional surgical time. He was to be referred to an outpatient wound care center to perform wound care on his wounds over time to facilitate healing. He simply left the hospital again and this time did not return.

Cancelled surgery and frequent phone calls from the hospital are revenue neutral events. When taken into account with practice overhead, this is a loser. A surgeon cannot make a living on surgery he does not perform. Patients who do not comply with medical advice can still result in lawsuits against a doctor.

So plastic surgeons who choose not to take clients like these greatly simply their lives. Those like myself who do serve some of these clients learn to be selective.

Best Regards,

John Di Saia MD

Originally posted 2013-09-18 07:30:31.

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

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.

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Travis Barker Plastic Surgery

Source: drunkenstepfather.com/index.php/2008/10/24/travis-barker-after-the-great-leg-fire-of-the-day/

Travis Barker was injured/burned in a plane crash and required some not-so-glorious plastic surgery (skin grafting) afterward. Here we see a skin grafted area on his leg. He should really be keeping this out of the sun. Many plastic surgeons also recommend pressure garments with silicone inserts to minimize scarring. Skin grafts do not always look so great but work for large wounds where many other techniques don’t.

Best Regards,

John Di Saia MD

Originally posted 2008-10-27 07:30:00.

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Dr D – When Skin Cancer Gets Large – Picture Alert

Most skin cancer is handled by non-plastic surgeons. When they get large, some get sent my way though. You might not be able to tell how large they are at times.

Look at this arm:

Large Arm Basal Cell Cancer with Hair Cover

Large Arm Basal Cell Cancer with Hair Cover

Large Arm Basal Cell Cancer with Hair Shaved

Large Arm Basal Cell Cancer with Hair Shaved

Large Arm Basal Cell Cancer Marked with Hair Shaved

Large Arm Basal Cell Cancer Marked with Hair Shaved

The point as you march through these images is to see that this cancer is pretty large. It has probably been there for years. The next page will have the wound formed when the cancer was removed and then two months after reconstruction in which I placed a skin graft and closed part of the wound using a little plastic surgery. Those who are faint of heart can skip this if they wish.

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Hand Trauma – Challenging Plastic Surgery – Picture Alert

Plastic surgery for hand trauma is at times challenging. In this case a nice man nearly took off his finger with a table saw. The instrument tore into his tendon and bone and removed a chunk of flesh. I will put some “Before and After” images after this first page so those wish to pass may do so easily.

Hit page 2 below if you want to see the images and read the rest of the story.

Best Regards,

John Di Saia MD

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Misconceptions – Cosmetic Surgery In A Foreign Land

Cosmetic surgery is expensive, so it is understandable that patients may seek to limit that cost. Some have gone to other countries in which overhead is not as high and surgery is cheap. Beware the case in which it gets too cheap however. Repair is rarely if ever cheap and sometimes the repair is limited improvement.

A woman posted the story of her friend on my old web site forum board. This poor lady went to Costa Rica for her tummy tuck. She developed a horrendous wound infection, lost tissue (skin necrosis) and was left horribly disfigured. You see evidence of skin grafts on her lower abdomen. The wound must have been huge. The planned week in Costa Rica became three months. At last contact with her, she was on disability.

Now don’t get me wrong: I review cases for the California Medical Board. I have seen domestic malpractice and poor outcomes. This Costa Rica case is the worst Tummy Tuck nightmare I have ever seen.

You can go to other countries to get your surgery much less expensively than here in the United States. Some of this cost difference is malpractice insurance, rent and other things about which you may not care. Other cost differences relate to the quality of the medical care with which you are provided. Powdered sugar on an open wound may be the quality of care in Costa Rica (as occurred in her case by her report,) but that doesn’t pass muster here.

Many patients leave the US and have successful outcomes. Just take into account the risk: benefit profile before you board that plane.

Best Regards,

John Di Saia MD

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