Bungled biopsy fun!

May 15, 2012 12:37 PM

I stupidly allowed a dangerously incompetent dermatologist to take a punch biopsy out of my tummy. Now I have an open wound. Help me keep this sucker from getting infected until it granulates and heals.

IANAD. YANAD. YANMD. Nobody is a doctor here, but my own doctors are really sucking and not being helpful right now, and right now is when I need a bit of assistance. I can't really go to another dermatologist or get another opinion, due to insurance rules and also due to the fact that I have already spent all my money on copays this month and need to be able to eat.

So I have this recurring weird rash (I am 28 years old, caucasian, female, overall pretty healthy, but allergic to all sorts of different things). I went to the dermatologist to see if he could figure out what it was, and he decided to take a punch biopsy. In the course of this extremely simple procedure, he managed to not only hit a superficial artery (ugh, so much blood!), but also sewed some of his own hair into the biopsy site while suturing it closed. I thought he had removed all the hair and redone the sutures in the office, but he pretty clearly did not do that.

When I took the bandage off to clean the sutures 24 hours later (as I had been instructed to do), one of the sutures was way too tight and was starting to embed itself into my skin; a part of another suture also pulled itself out almost immediately and took a chunk of skin with it; and the whole thing had blond hairs that were NOT my own stuck into it.

I called the dermatologist's office about all these issues. He was distressingly cavalier about the whole thing, and said that it was okay to have random hairs sewn into my wound "because we suture scalp wounds all the time". I expressed to the dermatologist my opinion that it is not okay to suture random non-sterile foreign objects into patients. He said I could "try to pull it out if I really felt like it."

I felt like it, so I tried to pull it out. Unfortunately, I broke the sutures and they came out with it. The good thing about this is that I removed two inches of dermatologist's hair from inside the biopsy site. The bad thing about this is that the sutures were holding my wound closed and now it is completely open again. I washed it out with saline and put some triple antibiotic on it, and covered it with a dressing. It looks red but not infected (there was some gunk attached to the hair, but the gunk went away as soon as the hair was removed from the wound bed), and I think it has a decent chance of healing up normally, but my PCP doc tells me it cannot be resutured because it was contaminated with gross dirty hair.

So now I have a tiny, but gaping, open wound in my belly. It is noticeably smaller than it was yesterday, but it's still a little hole in me and I find it worrisome. I've been keeping it covered and moist, but I don't really know what else, if anything, I should be doing for it. Like I said, I can't really go back to the doctor and have them take a look, 'cause I can't afford to do so. Any ideas on how to get this sucker to heal up? I can't really talk to any of my doctors about this because I don't trust that derm guy, my PCP is a sweetie but actually knows less than I do about how wounds heal, and although I know a lot about wound healing and tissue regeneration, it's in more of an academic context. (And yes, I am formally complaining about the hair-raising treatment I received.)

posted by kataclysm to Health & Fitness (27 answers total)

kataclysm: "I am formally complaining about the hair-raising treatment I received."

"hair-depositing", you mean. And good lord that sounds truly awful. I would not be able to sound as put together as you are right now if this happened to me or a loved one. Have you thought about getting one of those butterfly bandaids that they use instead of stitches sometimes?
posted by Grither at 12:41 PM on May 15, 2012

How in the HELL did he manage to get HIS OWN HAIR into your suture? Was he sewing with his TEETH or something?....

How big is the wound? The dressing/antibiotic combo sounds like a good start, but if it's biggish you may want to call your insurance company and say "okay, look, here's the thing" and tell them what happened to see if they can waive the copay on one visit or something.
posted by EmpressCallipygos at 12:52 PM on May 15, 2012 [1 favorite]

Get a butterfly bandage from pharmacy?

I would consider putting Crazy glue there to hold the wound, but I am more prone to self repairs than most. YMMV
posted by JohnnyGunn at 12:52 PM on May 15, 2012 [2 favorites]

OK, so I had surgery that required a chest tube and the wound was a hole in my abdomen/side and verry slow to heal. I think you are doing the right procedure -- the saline with the gauze (and really push the gauze in, even to the point of it being sticky and a little pull-y to remove. Then clean with warm water and cotton ball, then saline/gauze again). It took my abdomen a solid 4 weeks of saline/gauze before I was dressing-free. By the way, YMMV, but my doctor said no ointment, just the saline. Good luck. What a creep.
posted by thinkpiece at 12:55 PM on May 15, 2012 [1 favorite]

This is not a question for ask metafilter. You need to call your dermatologist office again and demand to be seen by a different doctor at the practice. Failing that you need to be calling your PCP's office again and ask for a referral to someone who might be able to give you a second opinion or who might advise you over the phone. Plan C is you call your insurance company, local emergency room, nurse helpline, etc. Bottom line is you need some other medical professional to AT LEAST advise you on what to do to take care of yourself.
posted by Katine at 12:55 PM on May 15, 2012 [9 favorites]

Oh, and I did it 2x a day.
posted by thinkpiece at 12:56 PM on May 15, 2012

Response by poster: EmpressCallipygos: I have NO IDEA how he managed that. I can't even find anything like it using Google, for heaven's sake, which means it's a truly novel way to be a fuckup. It's a very small wound: it was made with a round tool the size of a pencil eraser. It sort of is stretched into an ellipse shape now because skin is under tension, but it has healed a bit and I'd say it looks to be about 5 mm long and 2 mm across.
posted by kataclysm at 12:56 PM on May 15, 2012

You've already got roughly the right idea, but your wound should still be closed and sutured. An nurse at an urgent care facility should be able to do this for a somewhat reasonable fee, call it urgent care and your insurance might also be reasonable. I'd get on the horn with your insurance provider's nurse hotline service and ask them for advice about the extent of your coverage.

I am a microbiologist, but I am not your microbiologist and this does not constitute microbiological advice, but your dermatologist is dramatically and bizarrely in the wrong here. Suturing ones own hair into a scalp wound is a fantastically different thing than suturing foreign hair into a belly wound. This puts you at significant risk for all kinds of nasty staph infection fun; if that shit gets infected, or even smells weird, GO TO THE ER IMMEDIATELY. Intervening early in Staph infections is incredibly important and, especially in an area that can't be chopped off, can be life saving.

If anything nasty does come of this, don't worry about paying for a damn thing and hire a lawyer, his insurance will take good care of you one way or another.
posted by Blasdelb at 12:56 PM on May 15, 2012 [3 favorites]

Could you go to an Urgent Care clinic? Also, ew ew ew. This is why you cover your hair when you do surgery! Even minor office surgery!
posted by mskyle at 12:57 PM on May 15, 2012

JohnnyGunn: "Get a butterfly bandage from pharmacy?"

This is a really bad idea.
posted by Blasdelb at 12:57 PM on May 15, 2012

I'd probably get it seen to by a real doctor, but if you don't, your absolute best bet is a Band Aid Advanced Healing bandage, like this. The box says it's for blisters, but don't believe it. It's actually a hydrocolloid gel bandage that seals over the wound, trapping all the fluids and keeping it absolutely clean and protected. It stays on for a few days, and the gel inside sort of swells. It's weird, but it works like magic.

I used these to heal a nickle-sized spider bite crater in a week that regular bandages and neosporin hadn't helped for 10 days previously.
posted by mostlymartha at 1:03 PM on May 15, 2012 [4 favorites]

Also, if you want to get his attention, get your PCP's office to send him a certified letter demanding that he be tested for MRSA carriage.
posted by Blasdelb at 1:05 PM on May 15, 2012 [8 favorites]

my PCP doc tells me it cannot be resutured because it was contaminated with gross dirty hair.

That seems weird. Wouldn't nearly every wound be contaminated with something?

I mean, the hair is gross, but it isn't plutonium.

I kind of think you need to get it addressed, because if nothing else, it will heal weird and be this little pit scar that you'll always notice and remember the time that guy sewed his hair into you.

(By 'addressed' I mean talk your PCP into with the caveat that you'll get them removed if it gets infected, or you'll run to the emergency room, or whatever. Sweet talk someone into cleaning and suturing it for you, in other words.)
posted by A Terrible Llama at 1:07 PM on May 15, 2012 [1 favorite]

I washed it out with saline and put some triple antibiotic on it

Check the label. These products often say that they are not to be used on puncture wounds, as well as not to be overused (too often in a given day or for more than X-number-of-days). If you ignore these warnings (I doubt one application would cause a problem, I mean regular use on a puncture wound) you may have a reaction that looks like the wound is getting worse/infected.
posted by K.P. at 1:12 PM on May 15, 2012

I treat a lot of pressure sores and I never use antibiotic ointment, just wash with normal saline or sterile water, pat dry with sterile gauze and then keep it covered. Depending on the wound changing the bandage daily may make it worse, some absolutely need changed daily. Can you get some phone advice from the derm's office if not a free visit? And make sure you document all this well, including photos just in case something bad does happen later.
posted by yodelingisfun at 1:18 PM on May 15, 2012

If it were me, I would call the Dr.'s office again, and ask to speak to him. Once he's on the phone, I would casually mention that due to the continuing nature of the consequences of a procedure he personally did, and under "professional advice" that I will be recording this conversation. Before he can interject, I would calmly and clearly state my current condition and ask for his professional advice on how he feels I should proceed, and what his office plans to do to mitigate further inconvenience and/or damage to my body or health due to a procedure done in their care.
I would ask direct questions with reference to him sewing his own hair in me, and his "advice" to "pull it out if you want to". (If you still have the hair, please hang on to it, if you don't, I don't think it's a big deal to state that you do if he denies it.)
It's helpful to write down the exact questions you want to ask or get him to admit to before making a call such as this as he'll probably duck your calls from now on, and you want to make sure that you touch all the bases you need to during this conversation.

Foregoing that, I'd call my insurance company and see what they recommend.

Lastly, I had a small hole in my body which came about as a result of a ingrown hair gone awry. I removed the hair, and thought no more of it, until I felt some pain. When I was able to see it, there was a small circular wound that kind of looked like an abcess, and honestly kind of freaked me out. I kept the wound clean with a anti-microbrial hospital grade cleanser, and would apply neosporin to a band aid while I was going about my day and change this dressing 3-4 times so the open wound wasn't touching my clothes. At night, I would wash the wound again with the cleanser, apply hydrogen peroxide and then let it dry in the open air, and try not to sleep so it was contacting any surfaces. After about a week and a half, the wound closed much to my relief.

Full disclosure: This wound was on the side of a shaft of a certain body part which due to its flexibility and location, both made the wound very difficult to keep immobile, and scared the bejeezus out of me.
posted by Debaser626 at 1:25 PM on May 15, 2012

Urk! I've had many punch biopsies. This is obviously not the proper standard of care. If I were you, I would call your dermatology office again. They need to fit you in tomorrow, with a different dermatologist, to evaluate your wound's healing. Ask to speak to another derm on staff, because your original derm has not been responding to your concerns. Mention that it's red and gunky, as those are bad things that will motivate them to see you. They might just irrigate it and seal it with steri-strips (illustration, not real wound picture), which are butterfly band-aids with incredibly strong glue. There's a smaller chance of infection when it's sealed, and you can leave it alone to heal rather than possibly introducing bacteria with cleanings and packings.

Offices have flexibility with copays and billing. This would be a good time for them to squeeze you in and not bill you the copay or the insurance company for that 10 minutes of checking and fixing. You might suggest they waive the copay, because otherwise you have had good experiences with that practice and want to continue as a patient. I mean, if you've seen them more than this once. (Avoid saying "lawsuit" or "malpractice", as this is a nuclear bomb phrase that might make them tune out.)
posted by BigJen at 1:45 PM on May 15, 2012 [1 favorite]

You need to alert you insurer right away; call your customer service line and tell them you have a complaint against this doctor. Tell them everything you've told us, with dates, times and doctor ID number, etc. They don't need to have this guy on their rolls. Ask them for the procedure for getting treatment for problems caused by provider error. See if there's any way you can do it sans copay. If they insist you pay, escalate it and keep complaining, if you can. There's no reason for you to have to pay for your doctor's error. And you should definitely get treated right away.
posted by emjaybee at 2:23 PM on May 15, 2012 [5 favorites]

Can you call a different dermatologist and explain the situation? I would NOT go back to the other guy's practice even if I could see another physician there. Gross.

(Also, I got seven stitches last Thursday after an unfortunate Leatherman-in-bed incident and this post made me scrutinize those little buggers like crazy. After I uncurled from the fetal position, that is.)
posted by easy, lucky, free at 2:48 PM on May 15, 2012

Also, if it's started to heal, they may not be able to stitch it. It's my understanding that once the edges of a wound start to dry out, there's no way to make them heal together again. I waited eight hours to have my cut evaluated, and was told that I was at the outside edge of the time frame for sutures.
posted by easy, lucky, free at 2:52 PM on May 15, 2012

I had an MRSA infection that resulted in an open crater wound on my stomach that was pretty nasty. I had to keep gauze and ointment on it for about six weeks before it was fully healed. It sucked.

Definitely contact your insurance company so this can be documented. If you have to sue for malpractice (if things really go south) you'll want it in their computers.
posted by tacodave at 3:21 PM on May 15, 2012 [2 favorites]

A Terrible Llama: "That seems weird. Wouldn't nearly every wound be contaminated with something?

I mean, the hair is gross, but it isn't plutonium. "

In terms of answering the more academic questions that AskMe can actually address,

The primary problem with this kind of wound contamination is microbial. Hair will contain gram +ve bacteria adapted to living commensally on skin that can turn parasitic in the wrong kinds of context, contexts like an open wound. The OP's immune system has not had a chance to adapt to her dermatologists microbiota, and it hasn't adapted to her, making it particularly dangerous. On top of the hair getting into the wound, the dermatologist callously left it there, leaving anything on it a chance to colonize and providing a route of transmission into the wound for anything else.

MRSA is a significant concern as, particularly since this dude is a healthcare worker and A FUCKING DERMATOLOGIST, he is more likely that not a carrier.
posted by Blasdelb at 3:53 PM on May 15, 2012 [2 favorites]

Best answer: Punch biopsies usually aren't even sutured so this guy sounds suspect in multiple ways. At this point (24-48 hours after the fact), the best thing to do is keep it clean and allow it to heal by secondary intention. Don't let someone suture it at this point. You don't need sterile saline or any fancy crap, just good old soap and water. Pat it dry, cover with band-aid. A wound that small will heal in a few days and leave a little pock mark scar. If you want to use antibiotic ointment, don't put it on like you're frosting a cake. A little dab will do you. I've seen some nasty anaerobic bacterial infections from overuse of Neosporin and the like.

Blasdelb is correct that pretty much all of us (doctors) are colonized with MRSA. If it starts to hurt, ER. If it gets red, warm and angry looking, ER. Fever, chills, feel like crap, ER. But that is very unlikely to happen at this juncture. Although this guy's surgical skill is subpar, the cost of the biopsy and subsequent testing is sunk at this point so I would recommend following up with him at least to get the results, otherwise you will just pay someone else to do it again. Good luck.
posted by karlos at 4:22 PM on May 15, 2012 [4 favorites]

Make sure you are documenting everything and you get a copy of your medical records from this dermatologist - especially the records that state that he got his hair in your wound and had to take it out. Then provide all of that information (copies) to your insurance company and file a complaint against the doctor. If he/she is part of a medical system (like a university system, Kaiser, or the like), also file a complaint with that medical system against the doctor. This is atrocious and I am so sorry for you. Also, you may need to go to an urgent care clinic or emergency room to get this taken care of, I'd be concerned about infection.
posted by echo0720 at 5:12 PM on May 15, 2012 [1 favorite]

I've had several punch biopsies (like 9) over the past 3 years, and as someone mentioned above none of them were ever sutured. I don't think you need to worry, especially if you are not showing any signs of infection now. Keep it clean, and after a couple of days should not even need to be covered. If any redness or heat in the area, I'd use the antibiotic cream, but barring that you should have no worries from this. Sounds like you had a gross experience, but your wound will probably heal up just fine.
posted by freejinn at 9:39 PM on May 15, 2012

While agreeing with pretty much everything else upthread, I'll just mention that I've had some punch biopsies that were sutured. The dermatologists' explanation was, I believe, that those were on areas that get subjected to excessive stretching (one was at the shoulder joint, for instance). The point being, as best I understand it, to keep those edges in contact while healing.

But, yeah, get that looked after pronto and insist that it be paid for by that dermatologist, his partners, or his malpractice insurance. Which is their choice.
posted by nakedcodemonkey at 6:06 PM on May 21, 2012

Response by poster: Final update: I did pretty much what karlos said, except I washed with saline (because I had it), cut a Tegaderm dressng into small pieces (because I had them), and kept it covered with the Tegaderm to keep it moist. I changed the Tegaderm every 3-4 days.

It healed by secondary intention without any problems.
posted by kataclysm at 8:58 AM on May 22, 2012 [1 favorite]