On a cold Friday the 13th in January 2012, Stanley Payne,of Harrisonburg, was cutting down trees in the woods when a leaning hickory tree kicked back, slammed into him and threw him 15 feet. He tried to get up, but couldn’t. His left foot was hanging in the wrong direction.
“I knew my leg was badly crushed,” says Payne, now 64. “So I tried to crawl, but my bones were popping and crunching.”
Concerned that a sharp edge on a broken bone could sever an artery, Payne decided just to lie still and wait for assistance. He was alone that day in the woods because his son, with whom he works in the family logging business, had taken the truck in for repairs.
Payne yelled for help, but it was two hours before a neighbor heard him and called the rescue squad.
After arriving at Sentara RMH, Payne learned that his left leg was badly damaged and was getting worse by the minute. He had compartment syndrome, a situation in which pressure was increasing within the injured leg due to internal bleeding and swelling. If such pressure becomes too great, it can reduce or block blood circulation in that portion of the leg, causing permanent damage. In short, Payne’s condition was very serious.
Helping to Save a Leg
While many people don’t typically associate plastic surgery with limb-saving procedures, Payne’s health and well-being might be very different today without the skin grafting performed on him by Saied Asfa, MD, of Asfa Plastic Surgery & Medical Spa.
While Dr. Asfa does offer a wide array of cosmetic procedures, about half of the surgeries he performs are actually reconstructive or medical in nature. Reconstructive procedures are used to treat numerous conditions, including skin cancer, open wounds, scar tissue and recurring hernias, as well as to restore breast tissue following a mastectomy.
“In a case of compartment syndrome like Stanley’s, complications can set in when the muscles aren’t able to receive oxygen, which prevents healing and may even necessitate an amputation,” adds Dr. Asfa.
In an effort to save Payne’s leg, Sentara RMH orthopedic surgeon Dr. William Lennen performed a fasciotomy, making incisions on either side of Payne’s leg to relieve the pressure and restore circulation to the muscles and blood vessels.
“Without the fasciotomy, the blood vessels would have collapsed,” Dr. Asfa says. “The orthopedic surgeon had to leave the incisions open, which left Stanley with large wounds that required further attention.”
Left alone, Payne’s wounds could have taken months to heal, so Dr. Asfa was brought in to manage Payne’s wounds soon after the fasciotomy was completed. A few days later, he performed skin grafts, during which he took skin from Payne’s thigh and applied it over the wounds.
“With a skin graft, the body creates new vessels to supply blood to the grafted tissue,” Dr. Asfa says. “The process only takes about four to seven days.”
Although Payne’s leg fracture would take several months to mend, the skin-grafted incisions had completely healed within just two weeks. Thanks to Dr. Asfa’s care, today Payne is able to walk just fine, and he continues to work in logging.
Helping Out a Hunter
A 1988 car accident left Glenn Smith, of Grottoes, a paraplegic. Having always been an avid hunter, Smith got involved with Wheelin’ Sportsmen, a hunt club for people with disabilities, soon after his injury. For someone in a wheelchair, Smith, now 59, is an active guy.
In 2012, Smith developed an open sore on his ankle where it was rubbing against his wheelchair. After many months, the sore had failed to heal due to reduced circulation in the area. Since Smith has no feeling from the waist down, he couldn’t feel any pain from the sore, but he could certainly see it bleeding and oozing fluid. He had to change the bandage every day to prevent it from seeping through his socks. The wound had become a nuisance.
Smith’s primary care physician recommended that he see Dr. Asfa to heal the wound.
“After two years with this wound, Glenn had an infection that needed to be cleared up with antibiotics first,” Dr. Asfa recalls. “Then I had to do a special flap.”
During the surgery, Dr. Asfa repositioned tissue from another part of Smith’s leg to his ankle.
“I was kind of skittish about it at first because it was a large wound, and I was afraid that anything rubbing on my ankle would prevent it from healing,” Smith remembers. “But Dr. Asfa told me it would be OK, and it was. I had a good recovery.”
When a patient is happy with the results, Dr. Asfa says he is happy with the results.
“After two years of messing with the bandage every day, he was free of that,” says Dr. Asfa.
As in many other cases, Dr. Asfa was the first to perform that type of plastic surgery in the Harrisonburg area. “Dr. Asfa is a great guy,” Smith says. “He did a great job healing my ankle.”
Medical Tummy Tuck
Edna Bennett,of Bridgewater, had “tummy tuck” surgery performed by Dr. Asfa in March 2017—but not for cosmetic reasons.
Bennett, 65, had gone through several abdominal surgeries throughout her adult life—including a hysterectomy, a hernia repair and a pelvic prolapse—leaving her with a great deal of scar tissue. The skin and muscles in the area were loose, which also affected the placement of her pelvic organs.
“When I walked on the treadmill or leaned forward, it really hurt,” Bennett says.
Seeing Bennett in such pain, her husband spoke about his concerns to his doctor, who recommended that Bennett see Dr. Asfa.
“The scar tissue was pulling on her skin and organs,” says Dr. Asfa. “It was really limiting her mobility.”
To correct the problem, Bennett had her surgery as an outpatient procedure at Sentara RMH. Not only did the surgery eliminate the excess scar tissue, but it also tightened her skin, helping to keep her organs in place.
“Now, walking or doing anything physical is much easier,” says Bennett, who enjoys exercising and working in her yard.
She is very happy with the results of the procedure.
“We are concerned first with functionality, so the patient can get their normal anatomical function back,” Dr. Asfa says. “Then we consider the aesthetics, so they will have the least noticeable scar. We try to put both aspects together during a plastic surgery procedure.”
Treating the Cosmetic Effects of Skin Cancer
Gregory Ritchie,of New Market, has twice seen Dr. Asfa for plastic surgery.
In September 2013, another surgeon removed a cancer from the corner of Ritchie’s eye near his nose. Following the procedure, the area looked rather unsightly.
“My nose looked like a wart had busted near the corner of my eye,” says Ritchie, now 51. “It looked terrible.”
Performing flap surgery to correct the issue, Dr. Asfa pulled down a bit of skin from Ritchie’s forehead—just enough to cover the site of the cancer surgery.
“Now I have just a small bump on my nose and eyebrow,” Ritchie says. “It looks much, much better.”
Then, in 2016, Ritchie was diagnosed with a basal cell carcinoma on his left forearm. He says it looked like a burn scar.
In this case, Dr. Asfa removed the cancerous cells and then performed another flap surgery, which healed nicely. After the second procedure, no other cancer treatment was necessary.
“Dr. Asfa was great,” Ritchie says. “He explained everything in detail, and I’m really happy about the improvements in my appearance.”
Dr. Asfa explains that facial defects pose a particular challenge for plastic surgeons—especially in the nose and eye areas. However, all plastic surgeries have one goal: a positive outcome for the patient.
“The main thing,” he says, “is to make sure the patient is happy with the results.”