By desperate appliance are relieved.
Or not at all.
Hamlet
Some may remember the following post from 9/29/11. There is some followup at the end.
Ngozi arrived at the hospital several days before I came. She was told that I was coming and might be able to help her. She reportedly has a recurrent Spindle cell tumor that has been operated on four times in the past-the last surgery being about 1.5 years ago. She has no evidence of metastatic disease so we decided to resect the tumor.
The surgery was quite dramatic. We had to remove all the skin that was involved, perform a radical neck, as well as remove the clavicle, the upper pectoralis major muscle, the deltoid muscle and part of the trapezius muscle. The capsule of the shoulder joint was completely exposed. We had a big hole! Using a somewhat radical solution to fill the hole, we mobilized the breast, removed most of the breast tissue and used the resulting skin as a cutaneous flap. In a few days we will cover the rest of the wound with a contralateral pectoralis flap. I hope this will be her last surgery.
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Specimen including deltoid and pectoralis
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Addendum (10/21/11) : After her big surgery, this patient was not nutritionally well enough to tolerate more operations so we dressed her wound and fed her well. She slowly improved. and her wound started granulating. At the time of my departure she is almost ready for discharge. Dr. Mike has agreed to do a skin graft in the near future.
Ngozi came back to visit today. The final pathology showed dermatofibrosarcoma protuberans-a non-malignant tumor, but one that can be very locally invasive. The surgery was radical but she is doing well.
