In some cases of massive surgery, such as that involved in removal of a cancerous breast or amputation of the lower leg, the wound doesn't always heal.
This is a problem which has plagued surgeons for years. Not that the complication is ever fatal. But it's such a nuisance. There's the bother of repeated dressings for the wound, the delay in receiving X-ray therapy, the need sometimes for a skin graft.
Following a year of research, Dr^ M. J3ert Myers, clinical instructor of surgery at Louisiana State university medical school, has found a solution.
Dr. Myers said, in his opinion, the surgical wound doesn't heal because the flap of skin resulting from the surgical incision doesn't always receive an adequate supply of blood. As a result, he explained, some of the skin tissue dies and healing difficulty follows.
The surgeon said that if a way could be found, during surgery, to determine whether there is adequate circulation throughout the entire area of the skin flap, measures could be taken to remedy the situation.
For 'the past year Dr. Myers and his colleagues have been trying out a drug, which apparently pinpoints the spots not receiv-1 ing proper nourishment from the blood. The drug is called fluores-cein. It's not new but the LSU scientists have found a new use for it.
It works like this: First the drug is injected into the vein of the patient undergoing surgery. Then, after about three or four minutes, the skin flap is -examined under an ultra-violet light.
"Fluorescein is a dye,M explained Dr. Myers. "When injected into the veins, it goes wherever the blood goes. Under the ultra-violet light it shines out as a bright yellow. When there is no yellow shine, we know that this is a spot which is not receiving an adequate supply of blood. It is important for the surgeon^ to determine which portion is going to live and which portion is not." The surgeon said that if an area over one-half inch in diam eter does not fluoresce or show UP yellow under ultra-violet light, tnat particular portion will die within a few days.
What to do about it? Dr. Myers believes that the non-fluorescent skin should be removed and that a skin graft should either be performed at the time of surgery or that the wound should be su-j tured under a bit more tension.
The surgeon said some physicians maintain the skin flap doesn't heal well because it has to be sewed too tightly. Others say accumulation of fluid under j the flap causes the tissue to die,; pointing out1 that the fluid gets between the flap and the nourishment bed beneath it. Then, ofj course, there's always the possibility of infection.
Dr. Myers said although all of these can be and sometimes are causes, he is confident the main cause is an interference in the blood supply leading to the skin flap.
"Blood coursing into the flap from the end still attached to the body," he explained, "is often inadequate when it comes to | supplying the entire length of the flap. In such a case any portion of the flap which does not receive an adequate supply of good blood dies." PHOTO: DR. BURT MYERS AND EQUIPMENT
light, dye trace blood circulation.
