PS lied on operative report about muscle repair. What can I do?

Question

7 days post op TT/Lipo. ER last night for pain in my side. Was given a CT scan. ER Dr says there is no sign whatsoever, including swelling, pain, tenderness, anything at all, that would lead her to believe that I have had my fascia repaired. I knew immediately coming out of the OR it hadn't been done. I have 0 pain in my abdomen except for my suture line. He told me he repaired it and it's written so in this operative report I obtained. Please help, I've been deceived. What can I do? Thank you.

Charles Galanis, MD · Answer

I can see how distressing this must be for you.  So sorry you are dealing with this so soon after surgery.  Hopefully, we can put your mind at ease.  The fascia - which is the tissue that contains the muscle - is not cut or "repaired" in a tummy tuck.  The fascia and muscle are pulled toward the middle of your belly with sutures that are invisible on a CT scan.  It is simply reapproximated to the midline by a few centimeters.  It would be virtually impossible to see evidence of this on a single CT scan.  The only scenario where you MIGHT be able to detect this radiographically is if you could compare preoperative and postoperative CT scans and actually took the time to carefully measure the distance between the right and left rectus muscle.  In the situation you described in your story, there is no way to make the claim that your ER doctor made.  With all due respect to the ER physician who I am sure was well intentioned, she is neither a surgeon nor a radiologist.  Her fascia "repair" comments reveal to me that she has no surgical training in her background that would qualify her to make such a statement.  My advice would be to take a deep breath and rest assured that it is far more likely that your surgeon told you the truth when he said he addressed your muscle laxity.  I would nonetheless strongly urge you to bring this to the attention of your plastic surgeon.  He or she should know that you had a medical episode so soon after your surgery anyway.  But I would point out to him/her what the ER physician said and that it has you concerned.I am so sorry.  Particularly after paying through and going through a big operation, this is not something anyone should go through.  But again I hope the voices of reason in this forum can help erase some of your concerns.  Thanks again for the post and good luck in your recovery!

Nelson Castillo, MD · Answer

Thank you for your question and I am sorry that you are dealing with these issues.  During a TT the muscle repair does not repair the fascia, it only reapproximates the fascia to bring your abdominal muscles back to the middle of your abdomen, so there may not be any obvious sign of a repair on a CT scan.  We obviously do not have access to your CT scan, and I can understand how frustrated and angry you must be, but I would strongly recommend talking to your surgeon and having them explain the results of your CT scan with you.  There is likely a very simple and reasonable answer to this issue.

Robert H. Hunsaker, MD · Answer

Ooph...where do I start. I had a patient accuse me of this several years ago. Despite my assurance, my operative report, the anesthetic provider's affirmation, the O.R. staff's reassurance, the documentation of the use of the type of suture that is ONLY used for the "midline muscle plication" - the patient and husband refused to believe me and continued with such aggressive behavior I finally threatened to , and did, call the police. Of course, they then wrote up very nasty reviews with that accusation. In this instance, I did challenge them to get an MRI to document it (not even being certain it WOULD) but they refused.In most plastic surgeon's' experiences, often times great interference in the doctor/patient relationship comes from seemingly well meaning individuals, sometime physicians, who opine about things they really can't/shouldn't because they don't have enough knowledge of the issue. That even occurs in this forum.Your story, if accurate as presented, to me seems like a CLASSIC case of this. Not only is this doctor commenting on something they have NO meaningful information on (the CT scan may not show anything) but what reason is there for the surgeon to lie? To plicate the muscles takes 10 minutes give or take five at an additional cost of a couple sutures. So, you are saying you believe someone with NO training or experience in this over the person who actually did this?Your surgeon should be notified the ER doc said this, but only as a heads up to him/her, not as an accusation that this unrequested information is true.

J. Garrett Harper, MD · Answer

There could be a myriad of reasons for this.  Sometimes, plastic surgeons have pre-printed operative notes because they do the same thing over and over the exact same way.  This is dangerous in some ways because if you deviate from your "norm", the note you typically use is a misrepresentation of what happened.  It doesn't mean there was any malice in what happened, but it is, perhaps, another potential explanation for your situation besides the fine points already brought up by other surgeons.  Either way, talk to your plastic surgeon.

Mark Filstein, MD · Answer

There so many things wrong with this story, I don't even know where to start...1. why did you go to ER 7 days post op and not call your PS first?2. the pain was in your side, the fascia repair is in the mid line,why was fascia repair  be addressed  at all?3. Why would they get a CT can???? other than charge your ins. or you for the test?4. ED doctor thinks that fascia repair would be causing swelling pain and tenderness??? A TT is not a part of ER doctor training, ER doctor has never done or seen a TT and judging from what you were told, does not know what he/she is talking about.5. Why are you so quick to accuse your PS of lying to you??? I would assume that you did a lot of research and went to see a few doctors before you chose this particular PS because you liked his results and trusted him.6. And why would your PS not do a fascia repair? Why would your PS not want you to have an excellent result?these are just a few questions that come to mind.

Tom J. Pousti, MD · Answer

I would suggest that you take a deep breath and communicate your questions/concerns directly with your plastic surgeon. With all due respect to the emergency room physician, I would give more weight to what your chosen plastic surgeon has to tell you than what an emergency room physician (who has very little to no training when it comes to tummy tuck surgery). It is most likely, that after you communicate your with your plastic surgeon, that your mind will be put at ease.   Best wishes for an outcome that you will be pleased with long-term.

PS lied on operative report about muscle repair. What can I do?

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