Case Presentations

A patient with a common problem will be presented.  Background information as well as treatment options will then be discussed.  Please remember, there is often more than one acceptable treatment option.  Our goal is to present options that are “practical” to implement, that afford good patient outcome.

If you have a patient you’d like to see discussed, please contact us.

Click on a headline below to review the case details.

Case 7 part 4: Complicated lower extremity wound

by nadine on September 12, 2012

Here are photos of is the patient 1 month postop.  She is very happy!   DONOR SITE- thigh The donor site has almost fully re-epithelialized.  The patient should continue  applying gentle moisturizer to the area at a minimum of once each day for the next  6 months.         RECIPIENT SITE- Lower Leg [...]


So, now the wound is clean and covered with healthy granulation tissue and is ready for skin grafting. Donor site: The thigh is the most common split thickness skin graft (STSG) donor site because the area is easy to access and has a relatively large surface area allowing more than one strip to be harvested [...]


  Here again is the wound after debridement has been done.  There is no dead tissue, no important  structure exposed, and no obvious signs of infection.  The wound seems to have a healthy,  granulating  base.   What to do now?????   A wound with exposed bone/tendon/hardware is more challenging- because a skin graft or scar [...]


This case presents a patient with a complicated lower extremity wound with soft tissue loss and underlying fractures. The cause:  a road traffic injury, an increasingly common and growing problem particularly in low and middle income countries.  Because healthy soft tissue is critical for fractures to heal,  improper treatment can result in chronic wounds and [...]


History and Treatment options This patient (photo follows) also had a skin cancer on his nose, which left a significant defect.  Compared with the patient in Case #5, this wound is actually a bit smaller, but is in a more difficult location- off to the side, closer to the alar rim.  In this location, even [...]


Case 5: reconstruction of the tip of the nose

by nadine on December 19, 2011

        History Although difficult to distinguish at first glance, this patient has a basal cell skin cancer  involving a large portion of the tip of his nose.  The resection will leave him with a significant open  wound, similar to one caused by bite or other traumatic injury.  This case illustrates some important [...]


These 2 patients have what may appear to be similar wounds.  But upon close inspection, they are actually very different, with very different healing potentials.  In the table that follows, the first column lists the important issues which you must think about when examing a patient with a chronic wound. 2 wounds: similar in that [...]


Post image for Case 3:  Hand injury:  severe burn scar contracture

History: Over a year ago, this 3 year old boy burned the palm of his hand and fingers.His hand function is now severely limited because his fingers are essentially stuck into the palm of his hand. Physical Exam: Tight scar tissue connects the fingers into the palm.  The thumb has  some free motion, but all [...]


Case 2: Complicated Lip Laceration

by nadine on March 28, 2011

Post image for Case 2: Complicated Lip Laceration

History: This patient came into the ER with this terrible looking lip laceration. Before addressing the injury, first, be sure there are no other more life threatening injuries.  Ask the patient about what caused the injury to get an idea if you need to be concerned about something more serious.  For example, if this injury [...]


Case 1: Complicated Wrist Injury

by nadine on March 25, 2011

Post image for Case 1: Complicated Wrist Injury

History: This patient was in a car accident several days before we saw him.  He was initially treated in a rural clinic, where his open wounds were washed and loosely sutured closed.  He was then referred to our hospital for further treatment. Pertinent physical exam: On exam, the suture lines are clean, and the area [...]

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