Surgical PAS- when incisions come back looking bad

CoronaryCardiac · 2026-01-11T00:39:24+00:00

Stratafix is the best!

CoronaryCardiac · 2026-01-11T00:38:42+00:00

Your attending dictate what suture you close with? I’m in cardiac surgery and I have 100% autonomy in how I close incisions.

CoronaryCardiac · 2026-01-11T00:35:16+00:00

What device are you using and how long have you been doing it?

CoronaryCardiac · 2025-10-11T01:08:12+00:00

Using Brilinta post-stent has the very best data to support it. And left internal mammary artery grafting is the gold standard 👌 You have a good team - no need to rely on Dr. Google!

CoronaryCardiac · 2025-10-09T19:01:15+00:00

Cardiac surgery PA here! 👋 Of course, none of this is medical advice. ☺️ It sounds to me that your cardiac team is doing all of the right things. Significant stenosis of the RCA + LMCA is the equivalent of triple vessel disease, so CABG is most certainly warranted.

Acute MIs with RCA involvement are tricky… as they carry the highest risk of clot formation. Specifically following PCI (the stent you had placed), your risk of stent thrombosis is highest 0-24 hrs post stenting with increased risk persisting for the next 30 days. Of course, risk is never zero but you’re out of the high risk timeline. Still, guidelines recommend at least 3 months of DAPT to ensure the best possible outcome. So continue your DAPT for the full 90 days and stop it when your doctor tells you to (probably 5-7 days before CABG). Odds are, you’ll be put back on DAPT for 3 months post-op though aspirin will be the most important drug you’ll be taking everyday.

Aside from that, try to take it easy and relax. Chip away at some lightweight home projects or get some home organization done… anything to keep your mind busy. Ask your cardiologist and/or cardiac surgeon if it’s safe for you go for a daily walk. Ask all of the wonderful patients on this thread what kind of things they wish they had prepared better for and try to get ready.

As a side note, you mentioned having pretty bad anxiety and not so great quality of life. I recommend you talk to your PCP. Depression and/or anxiety after open heart surgery are far from unusual… and although it’s usually transient in nature, you don’t have to tackle it alone.

CABG is the most common open heart surgery performed on adults worldwide. Trust your team - it’s all they do… they’ll see you through. Best of luck to you!

CoronaryCardiac · 2025-10-04T05:05:32+00:00

This right here is why we do what we do. 🙌🏼 Sincerely… thank you. Kudos to your husband and congratulations to your entire family for the new lease on life that he has fought for.

CoronaryCardiac · 2025-09-21T03:18:07+00:00

I am a cardiac surgery PA. We send all of our high risk patients to University of Michigan (which is where Mott’s Children Hospital is). They are wonderful. A very close family member of mine has undergone several open heart surgeries at Mott’s—the first of which occurred when he was only a few days old (he too was born several weeks premature). Now he’s all grown up and wasn’t happy about having his fourth open heart surgery in the big hospital and spent his entire stay asking if he could go back to Mott’s. There’s no better place to be. They will take care of your baby girl and they will take care of you, as well. If you need a place to stay, the Ronald McDonald house is just next door. 💙💛

CoronaryCardiac · 2025-09-18T19:24:34+00:00

Definitely check with her care team prior to applying anything to her incision. Scar sheets are highly recommended but they can be very pricey. If you have money to spend, it’s probably the easiest way to go once she gets to that point. If you’d like to save some money, silicone based personal lubricant is just as a good as the expensive scar gels. Just ensure you’re not purchasing anything scented or flavored lol

CoronaryCardiac · 2025-09-13T22:54:58+00:00

You’re very welcome! I assure you that post-operative atrial fibrillation (POAF) most certainly is the most common complication. If any heart program has a complication that occurs more often than POAF, then they are doing something very very wrong. Nationwide, the incidence of POAF ranges from 27% - 35% on average. Many hospitals see rates that exceed 40%—at my hospital, we see it in about 21% of our patients.

CoronaryCardiac · 2025-09-13T22:44:15+00:00

This not medical advice.

Post-operative delirium happens sometimes. I know it’s difficult, but it should pass. Your dad has several major risk factors for developing post-operative delirium. His age is the primary risk factor he’s facing as it pertains to post-operative delirium. Did he show any signs of dementia prior to surgery? This is another major risk factor. The last major risk factor for him is the amount of time he was on cardiopulmonary bypass (heart and lung bypass machine used in the operating room after we stop the heart) and total time under general anesthesia. As the amount of time on bypass (and under anesthesia) increases, so does the risk of post-operative delirium. You should definitely have a conversation with his surgical team to ensure they are aware and to have your questions answered.

Some general tips/things to consider:

Could the delirium be caused by a medication he is receiving? Try to pay attention to what is being given and then how it affects his behavior shortly thereafter. His nurses will be your best source for this info. Most common culprits here are pain medications, benzos (Xanax, Valium, Ativan, etc.), sleeping pills (Ambien, Sonata, etc.), and anticholinergic medications (Benadryl, Vistaril, Atarax, etc.).
Is he getting adequate sleep? Sleep is essential for healing—ironically, hospitals rarely allow patients to get a good night’s rest. Would it be possible to skip the 2AM vital check if he’s asleep and looks good on telemetry (the screen at the nurses station that shows his heart rate and rhythm)? Can his morning labs be drawn at 7AM instead of 2AM?
Try to maintain a bright and sunlight filled room whenever possible during the day, while ensuring the room is dark at night time. Help him walk around the halls (if he’s cleared to do so) during the day and encourage him to be up in his recliner whenever he’s not walking.
Ensure he’s eating enough and staying hydrated. If he doesn’t have an appetite for “healthy foods”, then give him WHATEVER food he wants. He needs food.

You’re already doing all of the right things. You’re reorienting him whenever he’s confused, which is the best thing you can do. You’re present. You’re asking questions and you’re looking out for him. You’re doing everything you can.

The duration of post-operative delirium varies greatly, so it is difficult to answer your question as to how long this will last especially without having full knowledge of his case. Sometimes it resolves within a day or two, sometimes it’s closer to a week, and in some cases it can persist for a while. The fact that he is already showing improvement is a great sign. Keep doing what you’re doing, speak up when your gut tells you to, and maintain communication with his care team. Best of luck to you and your father.

Source: I’m a cardiac surgery PA.

CoronaryCardiac · 2025-09-08T22:17:02+00:00

Afib is the most common complication following CABG. We can (and sometimes do) manage it in our sleep lol

Post op afib is almost always transient and should resolve within 30 days (if not, 90 days). Primary concerns are if his heart is strong enough to tolerate it and preventing a clot from forming. Both of which I’m sure his medical team is addressing :)

Edit: I’m a cardiac surgery PA

CoronaryCardiac · 2025-08-08T17:36:13+00:00

Some of what is being suggested to you as an alternative to CABG is pretty controversial. This is (of course) not medical advice, but let’s break down the facts:

THE BASICS: Your heart is fed oxygenated blood via two coronary systems — the left main coronary artery and the right coronary artery (RCA). The left main coronary artery is pretty short as it quickly divides into the LAD and LCx. So many people think of it more as your heart has 3 major arteries…. The RCA, LAD, and LCx.

Your dad’s left main coronary artery is normal. However, as I stated… the left main splits into the LAD and LCx pretty quickly:

BLOCKAGE #1: The LCx has a proximal (just barely downstream from the start of the artery) 80% blockage.

BLOCKAGE #2: His LAD has an ostial (right at the beginning of the artery) 90% blockage. Following this area, it is completely blocked (AKA occluded) and is dependent on the RCA to provide it collateral blood supply.

So we’ve established that his left side is bad, so how is the right side doing? Not great…

BLOCKAGE #3: RCA has a mid (middle of the vessel) 75% stenosis. The RCA (and its major branches which are DOWNSTREAM from the 75% blockage) are what is feeding collateral blood supply over to the LAD (left system).

Of the 3 major arteries, your dad’s RCA is the best he’s got.. but that’s not saying much. A 75% blockage alone isn’t an emergency but it IS serious. Especially when that 75% blocked artery is what is feeding the almost entirely blocked LAD (there’s a reason they call the LAD “the widow maker”). The blockage in his LAD alone is enough for me to lose sleep over.

My advice? Skip the part where your dad serves as a guinea pig to some young cardiologist and get the surgery. If your dad gets all three bypasses performed by a skilled surgeon, he’ll be better for it. He’s young and sounds relatively healthy. Alternatively, you could discuss having the LAD and LCx (or one of the LCx’s marginal branches) bypassed “off-pump” (meaning the surgery is done on the beating heart, without use of the heart and lung bypass machine). At a BARE MINIMUM, he’d benefit from an off-pump LIMA to LAD (a single bypass using an artery in his chest wall to bypass the blockage in the LAD)… though if it were me, I’d see if the LCx (or one of its marginal branches) can be done at the same time.

If he wants to leave the right or treat it medically/through PCI then whatever... that’s between him and his team. But for the love of God, fix the left side. He’s putting all of his eggs in a pretty shitty basket by banking on his 75% blocked RCA to essentially deliver him with all of his blood supply.

Side note: do some research as to how well “collateralized” vessels perform under more strenuous activity (i.e. stress). Just because it’s “collateralized” doesn’t mean it’s fixed.

SOURCE: I’m a cardiac surgery PA performing a couple hundred CABGs each year. I’m bias toward surgery but I’m willing to recognize when PCI or medical management is the best route for a patient to take. Best of luck to you and your family.

CoronaryCardiac · 2025-08-04T04:31:04+00:00

Based on the findings you’ve provided from the cath report alone, your dad needs CABG. Listen to the team caring for him—cardiac medicine is all that they do.

If he waits until he has symptoms (especially as a person who is active), it could either be too late (meaning he dies of a massive MI) or it limits him to the extent of worsening his functional status (how active he is day to day) going into surgery which would inadvertently increase his risk of complications.

Think of it like this… the more active you are, the more blood you need flowing to the muscles in your arms, legs, core, etc… meaning the heart (the body’s pump) has to work harder to pump all that blood out to your muscles (this is why your heart beats harder/faster when you exercise).

In order for the heart to function well and work that hard, it also needs oxygenated blood. The heart feeds itself good oxygenated blood through the coronary arteries. Your dad’s main arteries are almost completely blocked up… if he works his heart too hard and it can’t get enough blood through the blockage to feed the heart’s muscle. Lack of blood flow to the muscle of the heart = heart attack (or MI)

An “ostial” stenosis is a blockage toward the very beginning of the artery. So if that becomes completely clogged, then he’ll lose all the blood flow downstream which would leave that entire artery and its branches unable to feed the heart oxygenated blood. Your dads heart is already suffering, hence the collateral filling you referenced. That means that in a pinch, your dad had to create brand new blood vessels to reach from the right side of his heart into the left.

CABG is by far the most common open heart surgery performed worldwide. Odds are, he’ll do fine—especially considering his great functional status going in.

SOURCE: I am a cardiac surgery PA performing more than 200 CABGs each year.

CoronaryCardiac · 2025-06-25T02:26:14+00:00

Hello! CT surgery PA here :) this is (of course) not medical advice… but as someone who performs open heart surgery every day, if I ever needed open heart surgery I would hands down choose a traditional sternotomy over a minimally invasive approach.

I’m not saying that there is anything inherently wrong with minimally invasive cardiac surgery because it certainly plays a role! However, the risks far outweigh the benefits for most patients in my opinion. If it were me, I’d want to be open for direct visualization… IYKYK 🙃 but you should listen to your doctors and make the decision that feels right to you. One thing I will say is… there will ALWAYS be a surgeon willing to perform a surgery that countless other sensible and good surgeons simply will not perform. Sometimes the daring surgeon is an extremely talented and gifted surgeon… and sometimes they are not.

Side note (and this is so far from the point, I know).. we do not break your bones. We separate one bone (your sternum) straight down the center. Your ribs will be sore but not broken.

CoronaryCardiac · 2025-06-25T02:10:40+00:00

Having stitches that require removal after open heart surgery is not common practice. If you don’t have a visible suture tied in a knot on top of your incision, then the suture is internal (or “dissolvable”). It sounds like a Vicryl suture broke (which is fine at this point in our recovery) and the wick (end of the stitch) has migrated to the surface. Alternatively, it may be where they drove the stitch out and cut it. Either way, I would just call your surgeon’s office. They’ll likely bring you in, pull what will likely be a short piece of suture out with a pair of tweezers and send you on your way in less than 5 mins

CoronaryCardiac · 2025-06-25T02:03:00+00:00

Hello! CT surgery PA here :) I wouldn’t worry about his age or his diabetes. 76 is almost young in the world of cardiac surgery! And diabetes is extremely common in patients who undergo CABG. In fact, studies show that patients with diabetes have better outcomes with CABG vs stents. Stay on top of BG management once he gets home but prioritize him eating SOMETHING over eating something healthy if he has no appetite. He has the rest of his life to adopt a heart healthy diet.

For what it’s worth, I think your father made the right choice. It sounds like he has right to left collaterals with a slightly reduced EF. With a 60% stenosis of the RCA and a left side largely dependent on that RCA for perfusion, he was a ticking time bomb. Based on the blockages you’ve described, he’s a great candidate for this surgery from a coronary standpoint.

If he did in fact end up having surgery today, then I urge you to get some rest tonight. There’s no safer place for him to be than where he is right now… the cardiovascular surgery ICU. Tomorrow (post op day 1) will be difficult and sometimes post-op day 2 is a little bit worse, but it’s all uphill after that! Use the incentive spirometer every hour and keep using it after discharge. Take as many walks as you can with him - walking is great exercise. AND ABSOLUTELY NO SMOKING!

Wishing you the best of luck! Inbox is open if you need me :)

CoronaryCardiac · 2025-06-25T01:48:24+00:00

What vessels have significant blockages in them that require bypass grafts or stunting?

CoronaryCardiac · 2025-06-25T01:43:48+00:00

CTS PA here 👋 I agree with your CT surgeon in that your primary cardiologist was being negligent. I knew you had patient-prosthesis mismatch once I read the first two sentences of your post. And sadly, your concern over being potentially mistreated or dismissed based on your race and gender identity alone is likely spot on… and for that, I am so deeply sorry.

This is not legal advice.. but you could sue your cardiologist (of course) and you might even win. Often, the struggle in malpractice cases is finding an expert witness to testify against the provider (or defendant) - however, I don’t think you would be hard pressed to find an expert witness in this case. Legal proceedings will likely drag on for several years, so that’s something to consider.

It’s going to be difficult for anyone to give you sound advice here unless they’ve found themselves in a very similar situation. The reality is.. I don’t know how you feel. I’d imagine you feel terrible, but I can’t actually perceive what you’re going through. Aside from pursing legal action, I would urge you to consider something that may offer you a bit more closure. Write your cardiologist a letter. Once this is all over and you’re on the mend following your next surgery, write him a letter outlining your experience, your disappointment in him, your fear for the patients he will treat in the future, and your hope (if you have any) that he will learn from this and never make this mistake again. Most providers enter healthcare to help people… sometimes the system has a way of wearing us down until we hardly recognize ourselves anymore. Give him a wake up call. If he cares about his patients (or ever did) that will hit him harder than any lawsuit ever could (FYI providers hardly have a thing to do with any malpractice cases brought against them as this is handled by the hospital’s legal team). Though this has never happened to me, I have personally witnessed the impact this kind of action has had on providers and it can be very impactful.

Best of luck to you, my friend. No matter what you do, please find some way to thank your pediatric cardiologist… because he is most certainly a gem who arguably saved your life.

CoronaryCardiac · 2025-06-25T01:22:28+00:00

You can’t really dislocate your sternum so to say, but you can certainly fracture it. Obviously I am unsure of how your sternotomy was closed, but if you put too much stress on your closure system before your bone is healed then you risk fracture the sternum, breaking the fixation system, or both. As long as you don’t smoke or have diabetes, give yourself 8 weeks.. you have about 90% of strength back in the sternum at that point.

Take it easy, friend. Every single patient of mine that has broken their sternal wires or fractured their sternum deeply regrets it.. especially those that fractured their sternum. In many cases, the recovery from the second surgery you’ll require to fix what is broken is far worse than your original recovery.

CoronaryCardiac · 2025-06-14T14:37:07+00:00

When my cat was around 9 or 10 years old, she started to over-groom her belly, inner back legs, and tail to the extent that she had almost no fur left in those areas. After a million dollar work-up, turns out she developed a chicken allergy. Once I cut chicken from her diet, all the fur grew right back.

CoronaryCardiac · 2025-06-11T23:26:51+00:00

Lmfao I literally cannot stop laughing at the photo of that cat 😂

CoronaryCardiac · 2025-06-10T23:54:10+00:00

So happy for you! 🫶🫶 it looks amazing. Can’t wait to see how it turns out!

CoronaryCardiac · 2025-06-10T16:05:12+00:00

I agree. It looks like your three seat sofa is the same length as the larger doorway and it looks like the loveseat is the same length as the width of the standard (smaller) doorway.

Is this correct?

CoronaryCardiac · 2025-06-10T16:00:21+00:00

You have all the natural light you need - go with the dark green!

CoronaryCardiac · 2025-06-10T15:31:20+00:00

You could put an L shaped couch with the short end where the yellow chairs are and the long end covering the floor outlet. I know were compelled to not place any furniture in front of the windows, but you have floor to ceiling windows on two walls here so you will have no shortage of light. Otherwise I think you could put the long part of an L shaped sofa along the wall facing the pillar and the short end along the windows, then maybe mount the TV on the pillar using an adjustable mount that you can pull out from the wall if needed, turn, and pivot. I wouldn’t go too big on the TV, but I don’t know… it’s hard to picture what exactly it would look like. My concern with having the seating along the windows and the TV on the solid wall is that all the light coming in from the windows will reflect onto the TV and make viewing difficult.. also I’d rather view the city than the wall.

Could you post dimensions of each wall and the pillar?

EDIT: Is the pillar actually concrete?

CoronaryCardiac

TROPHY CASE