Innovative Treatment for Small Cell Carcinoma Excision Site

PMH:  Aortic  valve replacement 1984 which requires long term blood thinners, CABG 1984, AFib with MI 1984 result in spinal cord injury,  Trans ureteral bladder resection 2010, left hand mass 2012, cancer mass left hand 2013, excision of left hand mass 10/2014, split thickness skin graft December 2014.  Growth on hand since 2009  dx small cell carcinoma- mass increase in size in one year.

10/2014 Excision of left hand mass involvement 4^th and 5^th MTJ surgical wound   12 cm x 5 cm  tendon and bone exposed in wound bed.  Surgical team plan to return to the OR two more times post excision of mass.

10/20/14 Left hand wound debridement. Plastic Surgical team treatment plan to place Integra in one week. Patient reported significant pain and patient given hydromorphone IV.  

Pre-albumin  14 (10/14/14) 

CRP 2.81 (10/14/14)

10/16/14 PTT  72.4 H    Sec    25.1 - 36.5 

10/29/14 INTIAL NWPT with porcine small intestinal submucosa triple layer matrix

11/05/14  Second application of porcine small intestinal submucosa triple layer matrix and NWPT.  Wound bed with granular tissue – Plastic surgical team treatment plan   changed- due to wound progress plan for skin graft only.  Patient reported pain reduced.

11/12/14 PlasticMD assessment note:  L UE: clean looking wound of L hand, no purulence/ cellulitis. increased granulation tissue over previously exposed bone of

3rd MC + small part of extensor tendon to MF. 

11/27/14  Fourth porcine small intestinal submucosa triple layer matrix  placed. NWPT discontinued. Wound bed with hyper-granular tissue in peri wound- silver nitrate applied- no pain reported .  Team continue with secondary closure with porcine small intestinal submucosa triple layer matrix for two more applications to closure. Plastic surgical MD recommended to continue plan split thickness graft. 

 12/05/14  Split thickness graft – patient sent to OR 

12/10/14  Surigcal site healed and ready for therapy