General Surgery

Surgical Wound Treatment: Beyond the Physical

by Katie Kuehn

"Ethan walks with a bounce like he did when he was a kid. I'm sure I don't know most of the day to day, moment to moment improvements, but I know he's still amazed when he does something that he hasn't been able to do before," says Cris Zipf-Sigler, Ethan's mother.

Ethan Zipf-Sigler with a replica of a 427 Shelby Cobra,
that he and his father built together several years ago.

Ethan Zipf-Sigler was born with an angiokeratoma, which affected most of his left calf and ankle. “It began as a gray mark on the back of my leg,” says the 26-year-old Kansas City native. “And the older I got, the more it grew.” At 4-years-old, Ethan began with laser therapies to the back of his leg. These treatments continued through middle school. He visited several physicians and tried different treatments, but none were successful.

In his late teens, some physicians suggested excision and grafting—removing the infected area and replacing it with healthy skin—but the procedure had a long recovery time and possible side effects, which made Ethan think twice. So, he continued to live with it. And live with it was about all he could do. This wound, which bled constantly and was terribly painful, curtailed many things that most take for granted—wearing shorts, swimming and ice skating.

“When I began law school, I realized enough was enough,” says Ethan. “It was taking a toll on my social life and ruining my clothes because it bled so much.” He and his family made a conscious effort to look for other options, even if it took them across the country. This led to an appointment with plastic surgeon Stephen Milner, M.D., director of the Johns Hopkins Burn Center and surgical director of the Johns Hopkins Wound Center, who decided that excision and grafting was the best way to proceed.

“This large cobblestone-like wound was ulcerated and bled freely, even on slight touching which seriously interfered with all of Ethan’s activities,” says Dr. Milner.

What impressed Ethan about Dr. Milner and his staff was the responsiveness and support. In the past, Ethan explains, he would have to schedule procedures six to eight months ahead of time. When asked when he could remove it, Dr. Milner answered, “tomorrow.” And Ethan knew immediately he was in the right place.

Because Ethan’s MRI showed that multiple blood vessels were feeding and entering the wound, Dr. Milner consulted with chief of vascular surgery, Thomas Reifsnyder, M.D. Prior to surgery, Dr. Reifsnyder performed a procedure to decrease blood flow to the wound, and thus ensure a safer surgery.

During a complicated surgery affecting 50 percent of his lower leg, Dr. Milner removed the wound down to the muscle, then followed with a skin graft harvested from Ethan’s right thigh and resurfaced the wound.

When Ethan awoke from surgery, he immediately began to cry, not because he was in pain or scared, but because for the first time in years, he could feel his leg flat against the mattress. “I was just so happy it was finally gone,” he says.

Ethan spent several weeks in the hospital, working with the occupational and physical therapy team at the Burn Center. Two years later, Ethan still has a scar, but it does not bother him. Because for the first time in a very long time, he can wear shorts and ice skate with his friends—all the things he could not do before.

Healing All Wounds

It is estimated that almost six million people in the United States are affected by chronic, non-healing wounds. Recent advancements in technology and new treatments mean patients do not have to suffer in silence.

Patients should seek treatment for a wound if:

• There is increasing pain, redness, drainage or swelling at the site of the wound
• It has an odor
• It is open, looks infected, and or patient begins to run a fever
• Red marks begin to show at the site of or near the wound—on the hand and arm, marks will show going up the arm; and on the foot or leg, marks will show going up the leg
• It has not healed significantly within three weeks
• It will not heal and continues to open, bleed and scab over
• Patient has a chronic medical condition such as diabetes, peripheral vascular disease or are immunocompromised, and develops a wound below the knee.

To discuss a case or refer a patient call +1.443.287.6499.

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