TDAP Flap Testimonial

June 21, 2015

To Whom It May Concern,

On January 1st, 2013, I experienced some divine intervention when God brought an angel into my life. Her name is Dr. Julie Vasile.

In January of 2013, I was diagnosed with stage 3 breast cancer. Over the next 11 months, I underwent 20 infusions of aggressive chemotherapy, a total bilateral mastectomy, and 33 aggressive radiation treatments. In December of that year, I got the wonderful news that my cancer was in remission. Unfortunately these aggressive treatments led to many side effects; one of which was a huge, gaping wound that would not heal at the right mastectomy incision site. Sadly, 2013 (the year that I had cancer) was not the worst year of my life. 2014 (the year of dealing with the complications of the cancer treatments) was the worst year of my life.

This wound opened up in May 2014 and I spent 7 months trying to find treatment options and get referrals to someone who could close this wound. My general surgeon recommended a wound vac. When this did nothing to close the wound after trying for two months, I was referred to plastic surgeons, who recommended cutting the latissimus muscle off the back of my shoulder and tunneling it around to the hole in my chest. I had concerns because in the veterinary clinic that I own, we need our shoulder muscles to lift, move, and hold our large dog patients. I am a single person who does all my own yard and maintenance work at my home as well as the clinic. Some of my hobbies are gardening, bike riding, landscaping, and home DIY projects-all of which require strong shoulders and arms.

From May to December of 2014, I spent hundreds of hours and thousands of dollars on out of pocket seeking treatment options on my own. These included acupuncture, cold laser, e-stim, collagen therapy, some hyperbaric oxygen treatments, and several others. In December, I even referred myself to the Mayo Clinic where they attempted a partial thickness skin graft. It was a long shot and did not work.

I became desperate to get this wound closed and was extremely depressed. I felt conflicted because I wanted the wound closed, but felt that I would regret the removal of my latissimus muscle for the rest of my life.

On New Year's Day, I spent hours on the internet  for the hundredth time trying to research latissimus flap surgery or find a chat room or blog from someone who had been through the procedure and could reassure me about it, but I did not feel reassured. That is when I learned about the TDAP procedure. The TDAP procedure is a modification of the latissimus dorsi flap procedure and leaves the latissimus muscle intact. It transplants a perforating branch of the thoracodorsal artery with a paddle of skin and fat to close the area on the front of the chest. It was exactly the answer to my prayers. An article on TDAP flaps lead me to Dr. Vasile's website.

As soon as possible the next day, I called Dr. Vasile's office. The staff was so nice and understanding and arranged a phone consultation with Dr. Vasile later that morning. My previous experience with doctors was that I might be lucky to get 10 minutes of phone time. Was I every wrong! Dr. Vasile is the most compassionate and thorough physician I have every encountered. We spent an hour on the phone discussing my health history and the procedure. She really listened to my concerns, needs, and goals in getting the wound closed and resuming my life. After this long conversation, she said that she felt that I might be a candidate for the surgery, and could help me.

Since I live in Missouri and Dr. Vasile practices in the New York/Connecticut area, I was going to have to make two trips-one for imaging and initial consultation and then back again for the surgery. In the past two years, I have seen over a dozen doctors. Dr. Vasile is the first and only who who was considerate and understanding of my need to be away from my own practice for the shortest amount of time possible when scheduling my appointments. In mid-January, I flew to New York and met with her for the initial consultation. During this appointment, she was very thorough and meticulous, she answered all of my questions, and not once did I get the feeling that she was in a rush to conclude the appointment. She truly respected me as a person and a patient.

While I have reasonably good health insurance, it was no surprise that this type of specialized surgery so geographically far away from my home was not typically covered. But, Dr. Vasile's staff (Tammie and Tatum) worked with my insurance company. They are just as thorough and at their jobs as Dr. Vasile because within 36 hours, it was approved and EVERYTHING was covered just as if I had done the surgery at home.

My surgery was scheduled for February 3rd at Northern Westchester Hospital with a preoperative visit on Monday, the 2nd. Since there are no microvascular surgeons in my local area in the mid-west, I would need to stay in New York for follow up. I made arrangements to stay in the area for a week until my postop visit on Monday, the 9th. Most of the country is well aware of the relentless snow storms that were pounding the northeast coast area every 5-7 days this winter. On February 1st (Super Bowl Sunday), bad weather was moving  in and they were warning people not to get out on the roads on Monday. Dr. Vasile called me at my hotel and offered to meet me in her office that Sunday afternoon to get all the preop markings done so there would be no chance of having to delay or postpone my surgery scheduled for Tuesday morning.

The surgery went very well. I spent only one night in the hospital where I received excellent care from a team of specially trained nurses to monitor the incision and the blood vessels, and then I was released to return to my hotel for further recovery. Since the muscle is not transected, I was completely off of all narcotic pain medication 42 hours postop-only over the counter Acetaminophen and Ibuprofen were needed to control the discomfort. Dr. Vasile and her staff followed up with me my phone over the next few days.

Once again, on Sunday, bad weather was moving into the area and traveling was expected to be difficult on Monday. And again, Dr. Vasile called offering to see me in her office on Sunday for a recheck so that I would not be delayed to Tuesday in leaving the area. Since everything was healing appropriately, she released me to begin the 4 day drive back home and allowed me to stay a few hours ahead of the storm. I just have never known a human physician to be this considerate of a patient's needs.

That was 5 months ago. I am so thankful to Dr. Vasile and her staff, and everyone involved in the surgical procedure for the wonderful care that I've received. The wound is healed and I've completed 6 weeks of physcial therapy to regain the range of motion that was lost while that wound was trying to contract down during the 7 months prior to this surgery.

That open wound was interfering with every aspect of my life, causing me extreme pain, fear, and distress. But by closing that wound. Dr. Vasile has freed me from these things. I can once again enjoy a nice warm bubble bath or go swimming at the lake-you can't do these things with an open wound. I can once again cuddle my small patients and my own pets in my arms without fear of a toe nail accidentally scratching my chest causing pain, bleeding, or infection. I realize now that the wound was sapping all my strength and energy. In the past few months, I have gotten physically stronger, am able to keep up with the demands of my clinic much better, and have resumed doing my own yard work and riding my mountain bike. No less than 50 people (family, friends, clients, co-workers, and colleagues) have told me how much better, happier, or stronger I seem recently. My staff members have commented that I've been singing or whistling while I work again.

More patients (especially women recovering from breast cancer complications) need to be aware of these microvascular surgical options for reconstruction or wound closure. I am still surprised by the minimum amount of postop pain and the quick recovery time-much less than I believe would have been with muscle flap surgery. Dr. Vasile's meticulous attention to detail and true compassion for her patients makes her an outstanding physician. Her kindness and respect for her patients has gone a long way to ward restoring my faith in the human medical profession. Our health care system needs more doctors like her and I would highly recommend her to any patient needing this type of surgery.

Words cannot express how thankful I am to her for giving me my life back.

Respectfully submitted,

Teresa in Missouri.




Content Copyright, Dr. Julie Vasile