This Week in Plastics - Keloids, VAC

For the past holiday week the OR schedule has been lighter than usual as many of the surgeons have taken a vacation. Most of the procedures I have seen have been debridements or skin grafts. During the skin graft procedure, a very thin layer of skin, which may contain either part or all of the dermis (~15/1000 in thick) is removed from a donor site and cut to fit over the wound. In order for the skin graft to take, the underlying tissue must be healthy, vascularized, and granulated which is often achieved with the V.A.C. machine that I spoke about last week.

In addition to the OR, I have been able to see many very interesting cases during office hours. The nurse that works with Dr. Spector in office hours has shown me where many of the instruments and supplies are stored allowing me to assist Dr. Spector and be more involved with the care of the patient. One patient that has been coming in twice a week for V.A.C. changes has a very persistent wound. The patient had a hernia repair which left a large opening in his abdominal area. A hernia occurs when underlying tissue protrudes through tissue that usually encloses it (generally muscle). As in the diagram the intestines may break through the abdominal muscle wall and require repair (picture from: http://www.pbennett.com.au/images/abdominal_hernia.jpg). In the picture on the right, you can see the black sponge that has been placed over the open wound of a patient that is used with the V.A.C. system to aid in closure (picture from: http://www.emedicine.com/med/images/4884med3722-30 .jpg). The V.A.C. has helped to close the wound, but at a very slow rate and each week during office hours Dr. Spector debrides the wound of dead tissues. It is interesting to see the progress of the patient’s wound closure with the help of a simple suction machine. Many of the cases during office hours are post-operative check-ups, but occasionally there are pre-operative consults.

In addition to consults, Dr. Spector also performs minor procedures during office hours. A patient last week that had a severe case a keloids was treated with steroid injections. Keloids are collections of scar tissue that form after an injury or surgery. Keloids are cosmetically unappealing and are often quiet painful. In the picture below, you can see an example of a keloid (picture from: http://fig.cox.miami.edu/~cmallery/150/protein/keloid.jpg). In this case the keloids had formed after a spinal surgery which meant they were in a very uncomfortable position. Two treatments for keloids that show promise are compression and steroid injections. It is not completely clear how the steroids aid in smoothing out the keloids, but with the injections the patient can see definite progress in both the appearance and pain level of the keloids.