From Bad to Worse

Fast forward a couple of years. Although the scar tissue is irritating and unsightly, since it is on my shoulder I don't really see it, and I got to the point where I just accepted the itchyness and occasional burning sensation. I had talked to my primary care physician and she tried to make an appointment with a dermatologist on a couple of occasions, but the dermatologist office never called to schedule an appointment.

So one day I am talking to a different surgeon, Dr. Timothy Davis in Modesto, about a different procedure I was going to undergo, and while I'm in his office, I do the old - "Hey, while I'm here, can you look at this?" routine and I show him my shoulder. I tell him that there was talk of treating the scar tissue topically, and we both agree that the only real solution is to cut it out and re-do the surgery. I also told Dr. Davis that the excessive scarring was the result of an allergic reaction to the suture material used in the first procedure and I suggest that he contact Dr. Bailey's office and find out what kind of suture material was used in the first procedure so another reaction could be avoided. He tells me that he uses a synthetic material, and is absolutely sure that I won't react badly to the sutures.

I schedule the surgery with Dr. Davis in the hopes that I will finally have a somewhat normal looking shoulder, and the irritation caused by the scar tissue will be gone. Prior to the surgery, I ask him if he checked with Dr. Bailey's office to make sure that he won't be using the same material, and to my surprise, he acts as though he is completely unaware that we ever discussed my skin sensitivity issues and actually tells me that I didn't have a allergic reaction, and that it was actually the result of the incision site getting infected. I found this disconcerting as it is obvious that he isn't taking my claims of having a reaction seriously.

So he performs the surgery, but he doesn't use sutures for the entire length of the incision. Instead, he uses a product called Dermabond which is essentially like a strip of surgical grade tape that is placed over the wound and is intended to hold the skin flaps together and also provide a non penetratable barrier to keep out moisture, dirt, etc. Since I am face down on the operating table, and can't feel anything but some slight tugging, I am completely unaware of what he has done. Immediately after the procedure, I went into the men's room to take a look at the results. I noticed that the incision was much larger than I expected, and it has a purplish, reddish color. At the time, I thought the discoloration was possibly some pigment from the antiseptic that was used to clean the area prior to the procedure. The picture below was taken a few hours after the procedure was performed.











This picture was taken at the same time, I included it to give a sense of scale so one could see how large the incision is.

The following day, the meds have worn off, and I am now aware that something doesn't feel right. Although I expect some discomfort from having a large chunk of flesh being removed, this feels different - an acute burning sensation. Concerned, I call my primary care physician immediately, and am told that it appears to be infected. My doctor prescribes some antibiotics, and urges me to call Dr. Davis and have him take a look. Dr. Davis agrees to see me immediately, and here is what he saw. (see picture below)

As you can see, the skin surrounding the dermabond is extremely inflammed and agitated thus causing the discoloration that I had noticed immediately after the procedure. You'll also notice that compared to the first picture, the discoloration is much more pronounced and is also spreading.

Dr. Davis sheepishly tells me that the reason for the pain and discoloration is not due to an infection, but rather, I am having a severe reaction to the Dermabond. He also informs me that he had never seen this happen before, and unfortunately, the Dermabond cannot be removed as the adhesive is extremely powerful.

Great - Now not only am I having another allergic reaction, but the very thing I am allergic to can't be removed. I tell him I'm not going to simply live with the feeling of having my shoulder on fire for the next several days until the adhesive weakens. So he starts picking at the edges of the Dermabond with his thumbnail, and lo and behold, it starts to peel off. He is able to get most of it off, but a few small pieces remain.

At this point, I'm pretty pissed off. In my opinion, this was totally avoidable. Unlike my first surgeon who had no idea that I would have a reaction to the surgical materials, Dr. Davis was very much made aware of my allergies, and should have been diligent enough to make sure that anything he used in the surgical process would be safe to use on a patient with my history. Here's an idea - given the fact that the surgery took place on a Tuesday morning, how about if I dropped by the office on Friday afternoon prior to the procedure and they could have put some Dermabond on my back to see if I would have a negative reaction? Seems like a logical approach to me, but what do I know? I'm only the patient.

It gets even better - With the Dermabond removed, I can see for the first time just how ugly this scar is going to be. It's a very large and very ragged cut as you can see in the picture above. Furthermore, the sutures were only used in the top and bottom of the incision, and the entire middle part of the incision no longer has anything to hold it together. Hmmmm - this sounds familiar. See picture below

This picture was taken a few days after the Dermabond was removed. As you can see, the center portion of the incision is starting to separate and is also starting to ooze constantly. Once again, I contact Dr. Davis to have him take yet another look at his work. When Dr. Davis sees the latest condition of the wound, he is completely dismissive about it - almost as if I have now become a pest to him because I have had to make so many appointments for what should have been a simple procedure. I tell him that I am concerned about what is going to happen to the part that is separating and ask him if it is possible to re-suture it. He tells me that too much time has elapsed, and that sutures can only be performed on a fresh cut. He also informs me that his plan was that the Dermabond would hold the middle section, and unfortunately, that plan failed. So I ask him what can be done at this point, and basically says that there is no solution, but that the end result probably won't look any worse than the original scar.

Really? Not any worse? Geez - let's not set the bar too high here ! Apparently that is an acceptable outcome according to his standards and he puts a gauze pad on my back and leaves.

Granted, I'm not a surgeon, but I can already see where this is going based on my first experience. With nothing holding the skin together anymore, it's only a matter of time until it splits open leaving another hole in my back. (see below)

Yep, sure enough. A couple of days later it opens up to create a hole in my back about 1/3 of an inch in diameter, and quite deep. Like last time, I'm sure that this hole will eventually fill in with scar tissue as well, leaving me with the same problem, but now quite a bit larger and shaped like a jagged line.

Unfortunately, it gets even worse. The wound never heals properly and it feels as though there are empty pockets underneath the incision site that not only become irritated when I use my shoulder with any level of semi strenous activity, but the whole area becomes prone to infection because water, dirt, bacteria etc now can collect in the little resevoirs under my skin.

As you can see in this picture, the upper part of the scar has turned into a large welt. This occured as a result of doing some weight lifting that put pressure on that area. At the bottom of the scar, there is some wierd growth, almost wartlike that appears to have grown around some of the sutures that were supposed to dissolve, but apparently never did.

The morning after this picture was taken, I looked at my shoulder and noticed that the swelling hadn't subsided. I started to palpate the area, and I could feel something squishy underneath my skin. I pressed on it a little bit, and a huge volume of bloody pus literally belched out of my shoulder. I pressed again, and it started shooting out of my shoulder like a squirt gun. Yuck !!!!

So you are probably wondering why I have a picture of my bathroom mirror here. Look closely. Magnify it if you can. See those spots all over the mirror? That is pus that literally shot out of my shoulder and struck my mirror about 2 feet away. How disgusting is that? I'll tell you - disgusting enough for me to seek the services of a COMPETENT surgeon to hopefully fix this mess once and for all, and enough to make me want to take the time to create this blog so others will be forewarned that all doctors are not the same in their skill level, attitude, or their ability to listen to their patients.