A short YouTube interview by Robert Whitfield MD discussing his surgical practice of routinely sending explanted implant capsules, scars, and swabs for testing (protocol he considers standard of care) and a case where a patient had an unexpected E. Coli infection around an implant. He reflects on missing the infection initially despite long experience (career beginning in 2004), notes the infection’s likely gut/urinary origin, treatment with a sensitive oral antibiotic, and resolution of the patient’s fatigue after explant and treatment.
Questions this video answers
2004
You know, for everybody listening, you send caps on a cancer patient and the scar, because that's the most likely place you're going to have cancer again.
I don't think people understand how unique what you're doing is. And for, for example, most of the surgeons, when they remove an implant, they're not testing them. They go, oh, they look fine. And they just get rid of them. That's it. They don't. They don't test them. They don't even swab them.
He was trained to do reconstructive surgery, as I was, and it would have been heresy for me to ever take out a cancer patient's implant and capsule, not send it. Now, for everybody listening, you send caps on a cancer patient and the scar, because that's the most likely place you're going to have cancer again. And the scar. And then we sent swabs because I. That's. I was doing. I mean, that was standard of care to me.
That was not protocol. That was exceptional protocol.
She had an E. Coli infection. And so for everybody listening, the E. Coli is found in the gut and found in the urinary tract. That's not supposed to be found around implants. And so going back, I was like, how did I miss this? You know, I had taken care of thousands of patients over, you know, my career, which started in 04 with, you know, plastic surgery. And I was like, how on earth did I miss this? And I went back through all the labs and, you know, studies, and I was like, I don't know how I missed this. Her only symptom, she can't complain to fatigue, which, I mean, honestly, in. In my training, and people have gotten chemotherapy and radiation therapy, a bone marrow suppression. They. I mean, that was kind of universal that they had problems with fatigue. So I didn't think anything about that. And then she came back with an E. Coli infection that I then treated, you know, with a oral antibiotic, as it was sensitive and, you know, within, you know, the next week or two after treatment, and she had an explant, of course, well, what do you know, all of her fatigue went away.
