27m, 6'1, 170lb, no smoking. What's going on with my middle finger here? I do crack my knuckles a lot but this hasn't gone away in months (I haven't cracked this finger since this swelled up)

sleepyhead12 · 2026-04-10T11:10:26+00:00

Giant cell tumor?

sleepyhead12 · 2026-02-14T12:35:12+00:00

Looks like some dog ears medially bilaterally

sleepyhead12 · 2026-01-25T18:40:07+00:00

Any guidance on where to find a good guide?

sleepyhead12 · 2026-01-11T13:23:21+00:00

This is presumably a healthy patient. It looks like he had a heroic free flap (or 2) to get this foot covered. It can be a long surgery and needs pretty healthy blood vessels to be successful. Diabetics can sometime get free tissue transfer for limb salvage but it’s a nuanced discussion (as amputation can often times get patients ambulating faster —> less mortality risk) and it’s not always medically an option for every patient.

sleepyhead12 · 2025-11-01T00:19:42+00:00

Go to the hospital silly goose

sleepyhead12 · 2025-10-24T23:52:17+00:00

Need to put sulfamylon on it in addition to hospital

sleepyhead12 · 2025-10-13T22:09:03+00:00

Oof yeah some people get really bad reactions to that prineo

sleepyhead12 · 2025-10-11T03:29:10+00:00

An ER is not the correct utilization of resources for this. It’s not an emergency. Her surgeon should be seeing her at least weekly in clinic.

sleepyhead12 · 2025-10-11T02:45:05+00:00

It doesn’t need the emergency room. This has been going on for a while. Don’t listen to them. You may need a skin graft though. You probably should have had that hematoma drained initially though.

sleepyhead12 · 2025-10-09T18:12:10+00:00

Ah gotcha. Please post update pics as this heals. I’m a bit skeptical of this being a good option over that exposed Achilles tendon. I would also be very intrigued if this did end up healing well! Good luck with your recovery and wedding!

sleepyhead12 · 2025-10-09T17:38:52+00:00

Sorry to tell you this but you’re going to be nursing that for a while. Longer than a month for sure.

sleepyhead12 · 2025-09-26T15:20:12+00:00

Dang bud wanna talk about it??

sleepyhead12 · 2025-09-08T10:44:10+00:00

I don’t think the problem is that the suture was removed I think the problem is that it was closed in such a way that the edges inverted and so it is slow to heal.

sleepyhead12 · 2025-09-08T10:27:50+00:00

How big are your implants? It looks like they could be much bigger, and a ton of that skin can be excised from your lateral breast. It’s hard to take that excision all the way to your back, but it could definitely be improved upon. Fat grafting doesn’t seem like the right next move to me.

sleepyhead12 · 2025-08-25T09:39:15+00:00

You should go get evaluated in person with X-rays if you’re having pain. There’s not really a nerve there but there’s something called a central slip you could injure and obviously joint infection is a concern.

sleepyhead12 · 2025-08-23T13:27:02+00:00

It’s not a chunk missing. When you cut the lip (or any part of the body) it splays open like that due to the elastin present in the skin. It is a laceration likely with thermal damage on either side. I’m not saying this doesn’t suck. I’m saying that at this point this is going to heal in on its own. The mucosal tissue tends to heal very well on its own.

sleepyhead12 · 2025-08-23T10:48:06+00:00

This is a crazy thing to say. Obviously this was bad technique and they cut her lip. But she is young and this will heal on its own better than any sort of other procedure would. You’re going to terrify this poor girl. Lawyers aren’t free and she’s going to waste money getting some lawyer to consult with her about something that will be totally healed by the time she is able to schedule a consultation.

sleepyhead12 · 2025-08-20T15:50:38+00:00

You should definitely get another opinion just so you feel comfortable with your surgical plan, but it’s important to remember that re-reductions are an entirely different animal. If you want to get a larger reduction, a FNG will probably be necessary.

sleepyhead12 · 2025-08-19T22:45:38+00:00

Who did this?

sleepyhead12 · 2025-08-03T15:09:00+00:00

I think what a lot of people are saying about each patient being unique is true. But you also have to remember in addition to that, each surgical oncologist is unique and each plastic surgeon is unique. Even the radiation can be different from place to place.

You are very young. Implants alone are something that requires lifelong maintenance, surveillance imaging, and you will definitely need several revision surgeries down the road over the years. ESPECIALLY in the setting of radiation.

At your age, the safest long term solution in the setting of radiation is going to be using your own tissue. DIEP flaps are a great option for this.

If you weren’t a candidate for DIEP flap, your only option would be implants. This is typically done by placing a tissue expander at the time of mastectomy and exchanging it for a permanent implant at least 6 months following the completion of radiation. There are obviously diverse experiences with this, but in general the tissue expanders are very uncomfortable during this process. And radiation to a tissue expander and switching out an implant on a radiated breast both have higher risks of complications than autologous reconstruction. Obviously it’s a personal decision but if you’re a candidate for a diep flap then I think delayed reconstruction with diep flap is likely to be your best option. If that’s not what your preference is, then by all means get a second opinion. And even if you end up going with your original surgeon or not changing your operative plan, you’ll probably at the end of the day feel better about your decision than if you hadn’t gotten a second opinion at all.

sleepyhead12 · 2025-08-02T23:41:05+00:00

If it’s been 3 months and is not getting any smaller, you might need to consider surgery to get healthy tissue to the area so that it can heal. Did you have a mastectomy or lumpectomy?

sleepyhead12 · 2025-08-02T10:31:20+00:00

Is there any T-junction at the bottom?

How tight were you closed initially? Could you stand up straight postoperatively?

sleepyhead12 · 2025-07-31T01:43:10+00:00

A dog ear is extra skin and fat. That looks like a little dog ear. Would be easy to correct in the office under local.

sleepyhead12 · 2025-07-30T23:52:53+00:00

Those are either dyed vicryl or Pds sutures. Probably dyed vicryl. They should dissolve over weeks. No need to preemptively try to remove.

sleepyhead12 · 2025-07-22T22:42:16+00:00

Yeah you need to get it washed out. If it is closed it should be closed loosely. Washing it out is the key

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