Plastic Surgery For Wounds
I have come to recognize that I am an unusual plastic surgeon in that I spend a fair amount of time caring for the ugly as well as the pretty. In that sense my practice is as much of a hydrid as the car that I drive. :) Some people find themselves wounded and some of these wounds are not set to heal well or at all without some help. Plastic surgeons who do this type of work are not always so happy to share this aspect of their practices for several reasons. Firstly, this type of medically necessary plastic surgery really doesn't pay all that well and often results in much less than attractive results. Many surgeons do not wish to be equated to ugly results for fear that the public will discount them entirely when it comes to cosmetic work. The cosmetic business pays many of our bills. Remember the goals of reconstructive plastic surgery are primarily to obtain wound closure in cases in which it is unlikely or has failed for any of a number of reasons. This is why many consider this type of plastic surgery the darkside.
WoundsCare.org has been carefully named and positioned to give a taste of that darkside for those who are interested.
Facial Dog Bite Plastic Surgery
This woman was working with a dog as a groomer when the animal bit her lip leaving her with a severe injury. She came to the emergency department and they called Dr D. She was memorable of the patients I operated in my "emergency surgery years" as she was amongst few who despite having poor health insurance coverage actually paid her bill completely over many months. Her result was excellent at 10 months post-operative. I lead with this case as it is amongst the few in which the results are beautiful and virtually without scarring. This is very uncommon in reconstructive plastic surgery especially in traumatic cases. In essense, this was a home run.
Plastic Surgery for Pressure Wounds of the Backside (Sacrum)
Seeing debilitated people at the LTAC hospitals means seeing a large number of pressure wounds. Before I started seeing patients at these facilities, these wounds went pretty much unrepaired. If they couldn't heal with wound care, they didn't heal. Many of the patients with these problems are too sick to consider surgery. In this man's case he had not been able to get out of bed to a chair for a year or so, before I saw him. This was all he wanted as he had lost his ability to walk some years prior.
When you have such a large wound on your backside such that the underlying bone is exposed, sitting in a chair hurts, bleeds and can cause that wound to breakdown further. So he had a plastic surgery procedure referred to as a gluteal flap to cover the bone and close the wound. He was able to spend an hour or so a day afterward in a chair for the last eight months of his life. These repairs are not pretty, but they can return function and reduce or eliminate pain.
Surgery for Removal of Infected Sternal Wire from Prior Heart Surgery - Chest
Heart surgery frequently involves division of the sternum or "breast bone." The divided sternum is brought together after the surgery with wires usually and these wires occasionally can become infected.
In this case an infected wire became exposed in the wound months later. The wire was removed in a simple procedure at the bedside. Within a few weeks the wound had healed. Without removal of infected wires or sutures from previous surgery, these kinds of wounds heal incompletely or can become repeatedly infected with drainage. This is not really plastic surgery although in this case a plastic surgeon was involved. :)
Plastic Surgery for Open Wound from Prior Surgery - Abdomen
Not all surgical wounds can be surgically closed or remain closed. Surgical wound failure is a common problem for patients who ultimately come to admission to an LTAC. This patient had had a accident involving abdominal trauma and emergency surgery. His wound was considered too risky to operate for surgical closure during his prior hospitalization.
One of the options for care for a patient with such a wound is to simply apply dressings and keep it clean so as to allow it to heal on its own. This "Wound Care Only" method can be accompanied by a long period to closure or a failure to close entirely. This patient's condition allowed the option of plastic surgery to close part of the wound and place skin grafts over the remainder which Dr D performed.
While this does not make everything pretty, it does make things less ugly and facilitates (in this case by three weeks) closure of the wound. The lower left inset is of a similar wound in which "Wound Care Only" was performed (no surgery.) At six months from the original surgery, this wound still has a few open elements and even the healed area has left a permanent deep trench in the abdominal wall. This contour defect is much less pronounced in the surgically treated wound.
Soon to be added to this page: more skin grafts and wounds. Stay tuned.
Can Dr D Help With my Wound?
Dr D performs wound surgery, but has curtailed the practice in some ways. He no longer takes emergency room call [too many unpaid late nights!] so most of his wound surgery practice happens in the confines of the LTAC hospital system in Orange County. He consults upon and operates upon some patients in a few such hospitals within the Kindred system. Depending upon your exact problem and your insurance coverage if you are in one of these hospitals, he might just be able to help you.
© John Di Saia, MD... an Orange County
California Plastic Surgeon
Serving Southern California since 1997 * (949) 369-5932