Patient Develops Fatal Infection Following Skin Graft

Case Overview

This case involves a 45-year-old male patient who developed actinic keratosis on his shoulder blade after prolonged sun exposure. The patient’s dermatologist elected to treat the patient with cryotherapy. After the patient’s actinic keratosis was removed, the wound began to fester. The patient returned to the dermatologist’s office and was prescribed a topical burn cream. The patient used the burn cream for several weeks but saw no improvement. The actinic keratosis site eventually became infected and the patient ultimately required a skin graft. Following the skin graft, the patient was instructed to follow up every 2 weeks for 2 months. The first follow up appointment showed the patient was healing properly. By the second appointment, however, the patient had developed a subsequent infection in the graft. The patient was instructed to go to the hospital. While the patient was in the hospital, he became septic and died.

Questions to the Dermatology expert and their responses

Do you regularly treat actinic keratosis with cryosurgery?

I regularly treat actinic keratoses, and I have a specific research interest in patients with infection.

What complications may have caused the patient's outcome?

In this particular case, there are a few issues that need to be addressed. Did the patient have a known diagnosis of infection prior to the treatment of the AK? Was there a concern that the AK might be an early squamous cell? If yes, then a discussion of the possibility of infection should have occurred. That discussion would not, however, prevent me from treating a lesion that needed to be treated and biopsy or other methods might have also resulted in infection. Finally, did the patient have any other known medical problems? Complicating issues could include inflammatory bowel disease, myelofibrosis, or leukemia.

About the expert

This highly-qualified dermatologist has over 40 years of experience in the field. He earned his BS from the University of Wisconsin and his MD from the University of Michigan. This expert completed two residencies in internal medicine and dermatology at the University of Michigan. He is board-certified in internal medicine as well as dermatology. This expert is a distinguished member of the Medical Dermatology Society and the Association of Professors of Dermatology. He has a particular research interest in pyoderma gangrenosum and has published hundreds of articles on the topic. Formerly, he has served as an associate professor of dermatology at the University of Louisville School of Medicine and as the director of the dermatology residency program there as well. Currently, this expert is a professor of dermatology at a KY university and the chief of dermatology at a university-affiliated hospital.

E-008742

Specialties:

Dermatology

Dr. Wendy Ketner is a distinguished medical professional with a comprehensive background in surgery and medical research. Currently serving as the Senior Vice President of Medical Affairs at the Expert Institute, she plays a pivotal role in overseeing the organization's most important client relationships. Dr. Ketner's extensive surgical training was completed at Mount Sinai Beth Israel, where she gained hands-on experience in various general surgery procedures, including hernia repairs, cholecystectomies, appendectomies, mastectomies for breast cancer, breast reconstruction, surgical oncology, vascular surgery, and colorectal surgery. She also provided care in the surgical intensive care unit.

Her research interests have focused on post-mastectomy reconstruction and the surgical treatment of gastric cancer, including co-authoring a textbook chapter on the subject. Additionally, she has contributed to research on the percutaneous delivery of stem cells following myocardial infarction.

Dr. Ketner's educational background includes a Bachelor's degree from Yale University in Latin American Studies and a Doctor of Medicine (M.D.) from SUNY Downstate College of Medicine. Moreover, she is a member of the Board of Advisors for Opollo Technologies, a fintech healthcare AI company, contributing her medical expertise to enhance healthcare technology solutions. Her role at Expert Institute involves leveraging her medical knowledge to provide insights into legal cases, underscoring her unique blend of medical and legal acumen.