Joyce's KP Adventure mikepasini.com headlines
Meeting Dr. Holland
25 September 2025
Joyce had an appointment with Dr. Mike Holland, a new surgeon at the Kaiser plastic surgery department, after Jennifer the Wound Care RN referred Joyce to him.
So we found ourselves back at the place this adventure all began with Dr. Tong evaluating the radiation damage to her leg in 2020.
Dr. Holland received his medical degree from University of Virginia School of Medicine and has been in practice between 11-20 years.
We started with some history. He had fortunately familiarized himself with the case so there weren't many blanks to fill in. Or questions to answer.
Then he took a look at the wound, testing for any feeling around the leg and inside the wound. Dr. Tong had always been careful to avoid the nerves so Joyce had feeling everywhere but one spot inside the wound.
After he had a look, he dressed the wound so we could discuss Joyce's options.
I'd brought a bag of supplies to do the dressing, things I know the Department doesn't stock. And I handed them to Dr. Holland one at a time. Interestingly he only needed one of the large Mepilex bandages to cover the wound.
So it is smaller.
Then we discussed her options, starting with a question to Joyce. What did she want to happen?
She wants this adventure to end, she said.
He had three options for her, all of which involved cleaning any bacteria out of the wound first (there is always some in an open wound):
- Apply a layer of Integra to the wound with a week of Wound VAC, which can be managed at Golden Heights. If the wound and Integra grow together, she would return for surgery to graft a thin and fragile layer of skin harvested from her outside thigh to close the wound.
- Open the curled edge of new skin around the wound, compress them together and stitch the sides closed.
- Take a thicker elliptical patch of skin and blood vessels from her leg to help cover and close the wound, rerouting blood vessels to the keep the patch alive.
The first option is what Dr. Tong had thought of doing. But she felt the wound wasn't healthy enough for the Integra to adhere to the wound and therefore nothing for a skin graft to grow on.
But Jennifer the RN thought the wound had healed enough to evaluate it again.
I asked Dr. Holland which option he felt most comfortable recommending. He thought Option 2 with Option 1 as a Plan B if the wound won't close with Option 1. He thought her weight loss had made Option 2 much more feasible.
The advantages over Option 2 are that there would only be one dose of general anesthesia instead of two. And the advantage over Option 3 is that it would be less painful to recover.
She liked that approach. So he'll order blood tests and monitor her condition during October with an eye toward closing the wound in November. Much of that, like blood draws, can be done at Golden Heights.
Cross your fingers.