Debunked: Boston bombing recovery photo makes no sense from medical point of view

Cotran

New Member
fucarilerehab1.jpg
Image Source: https://www.bostonglobe.com/metro/2...regan/4fttzx4spJ8SRA8GQLAWuI/story.html?pic=9

03bombfucarile4.jpg

This is Boston bombing victim Marc Fucarile. He spent 45 days at mass general, 55 at Spaulding for rehab. Had right leg amputated, severe injuries to left leg including burns and fractured foot. These are from The Boston Globe, here is a link confirming that the top picture was taken when was transferred to Spaulding, scroll to number 5 the bottom pic is from Mass General http://www.bostonglobe.com/metro/20...regan/4fttzx4spJ8SRA8GQLAWuI/story.html?pic=9 Notice his stump in the bottom pic, despite some discoloration it looks like it's healing nicely and probably pretty far along in his stay. Which is great because in order to get transferred to rehab you need to be well healed.

However, notice the stump in the top picture where he is supposedly getting physical therapy at Spaulding. His stump is no longer healthy, in fact the color can only mean one thing, gangrene. How did his well healed stump turn to gangrene? And if it is truly gangrene, why would they release him from the hospital, it's kind of an emergent situation he could get septic and die- you take him to surgery, you don't do physical therapy on an amputee with a gangrenous stump.

Mod: the black is the foam dressing used in negative pressure wound therapy:
https://en.wikipedia.org/wiki/Negative-pressure_wound_therapy

Also notice it's covered in plastic with a tube coming from it, pretty sure that's "vacuum assisted wound closure" therapy VAC, where it produces negative pressure or suction to help certain wounds heal. The only problem is VAC is contraindicated in gangrene, you have to debride all the black dead tissue away before can use VAC.

Mod: See above, VAC is Negative-pressure wound therapy

Also notice the large tube sticking out of the bandages on the left, again he would not have released him and be doing physical therapy on him if he had kind of seeping infected wound requiring such a drain! I can't even imagine what it's supposed to be draining, he had severe burns, but even if they were fresh and seeping you dress them you don't stick a giant tube to drain burns. The only thing I can think of that would require such a tube would be if he had an infected surgical wound of some type, which makes no sense if he's in rehab.

Mod: It's the same tube going into the NPWT

One more thing that does not make sense, in the second picture he has a nasogastric tube in. NG tubes have limited applications- to feed patients food or drugs because they can't swallow for some reason, or to decompress the GI tract in a patient with bowel obstruction and things are back up the wrong way. In the latter case the patient would likely be in severe pain and on his way to surgery, not sitting comfortably in bed. So why does he have a nasogastric tube? Am I missing something? I can provide links for any of the above, first post not sure what I need to substantiate with links, in this post the pictures pretty much speak for themselves.

Mod: There are multiple reasons, see below.
 
Last edited by a moderator:

deirdre

Senior Member.
a quick google of "amputation vacuum" >images... they all look like that.
bl.PNG
 

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Bruno D.

Senior Member.
View attachment 18579 View attachment 18578
... His stump is no longer healthy, in fact the color can only mean one thing, gangrene....
... And if it is truly gangrene, why would they release him from the hospital, ...
... The only thing I can think of that would require such a tube would be if he had an infected surgical wound of some type, which makes no sense if he's in rehab. ...
... in the second picture he has a nasogastric tube in. NG tubes have limited applications- to feed patients food or drugs because they can't swallow for some reason, or to decompress the GI tract in a patient with bowel obstruction and things are back up the wrong way. ...

As @deirdre showed in Post #2, the black color in the picture is not the wound, it's the treatment (amputation vacuum) itself, and the tube is also part of the same treatment and not a nasogastric tube, I think that your doubts are clarified, Cotran.

He was in severe pain, but healing well, and ready for rehabilitation.
 

Landru

Moderator
Staff member
In fact a search for the image gets this
http://bppa.net/2013-contest/2013-feature-1st/
 

Spectrar Ghost

Senior Member.
As @deirdre showed in Post #2, the black color in the picture is not the wound, it's the treatment (amputation vacuum) itself, and the tube is also part of the same treatment and not a nasogastric tube, I think that your doubts are clarified, Cotran.

He was in severe pain, but healing well, and ready for rehabilitation.

I'd guess the tube on his chest in the second photo is a morphine button; the reflection off his cheekbone is deceptive but it passes behind his head towards the wall.
 

deirdre

Senior Member.
I'd guess the tube on his chest in the second photo is a morphine button; the reflection off his cheekbone is deceptive but it passes behind his head towards the wall.
he has something in his nose at one point. im guessing morphine too. bad veins or whatnot.
fakepatientboston001.png
 

deirdre

Senior Member.
NG tubes aren't just used for those two applications; when a patient has little to no appetite (for instance, due to pain or an eating disorder) they are used with a formula to get nutrients in, usually while the patient sleeps.
http://www.ncbi.nlm.nih.gov/pubmed/16831697
sorry didnt see your post.. kinda looks like its hooked to this bag... a "banana bag" maybe? ie nutrients ..nah bananas are IVs. probably food like you said.
168297810.jpg
 

Ray Von Geezer

Senior Member.
To add, reading up a bit on NPWT, it doesn't seem to be unusual for patients to undergo therapy or even discharge to home whilst undergoing VAC treatment (though that point may have just been raised because Cotran mistook the NPWT for gangrene). For example, this elderly above-knee amputee:-

http://jaoa.org/article.aspx?articleid=2094462

Ray Von
 

Cotran

New Member
Yes, it's a a black open-cell foam dressing used to spread the suction.
https://en.wikipedia.org/wiki/Negative-pressure_wound_therapy
View attachment 18594
Ok let's say it is exactly that, not gangrene. So we agree that it is VAC therapy- which is only used for open wounds. How did he go from the hospital with a nearly completely healed closed wound as in the second pic I posted, to an open wound when he left the hospital? How is that possible? Also you don't address the other tube on his left side, does that not also imply some type of open wound? What other purpose could it be doing there? So it means he has bilateral open wounds, I would think that would be a contraindication for physical therapy.
 

Cotran

New Member
To add, reading up a bit on NPWT, it doesn't seem to be unusual for patients to undergo therapy or even discharge to home whilst undergoing VAC treatment (though that point may have just been raised because Cotran mistook the NPWT for gangrene). For example, this elderly above-knee amputee:-

http://jaoa.org/article.aspx?articleid=2094462

Ray Von
But the picture of him in the hospital I posted shows that he did not have an open wound and it was almost healed, therefore no need for VAC therapy. Can you find me a link that shows there is a role for VAC in a closed healed wound as the picture clearly shows before he went to rehab?
 

Landru

Moderator
Staff member
But the picture of him in the hospital I posted shows that he did not have an open wound and it was almost healed, therefore no need for VAC therapy. Can you find me a link that shows there is a role for VAC in a closed healed wound as the picture clearly shows before he went to rehab?
When was each photo taken?
 

NoParty

Senior Member.
Last edited:

Mick West

Administrator
Staff member
@Cotran, if you want to make claims about the photos being "wrong", please provide the exact dates the photos were taken, and quote reputable sources for the claims you make about the applicability of NPWT/VAC
 

Cotran

New Member
NG tubes aren't just used for those two applications; when a patient has little to no appetite (for instance, due to pain or an eating disorder) they are used with a formula to get nutrients in, usually while the patient sleeps.
http://www.ncbi.nlm.nih.gov/pubmed/16831697

sorry didnt see your post.. kinda looks like its hooked to this bag... a "banana bag" maybe? ie nutrients ..nah bananas are IVs. probably food like you said.
View attachment 18593
NG tubes aren't just used for those two applications; when a patient has little to no appetite (for instance, due to pain or an eating disorder) they are used with a formula to get nutrients in, usually while the patient sleeps.
http://www.ncbi.nlm.nih.gov/pubmed/16831697
I just find it odd that they would need to force feed him, he looks a little too well nourished that they would have to resort to that this late in his recovery- but I could buy it being a morphine NG feed, possible. But the pic below
View attachment 18579
Image Source: https://www.bostonglobe.com/metro/2...regan/4fttzx4spJ8SRA8GQLAWuI/story.html?pic=9

View attachment 18578

This is Boston bombing victim Marc Fucarile. He spent 45 days at mass general, 55 at Spaulding for rehab. Had right leg amputated, severe injuries to left leg including burns and fractured foot. These are from The Boston Globe, here is a link confirming that the top picture was taken when was transferred to Spaulding, scroll to number 5 the bottom pic is from Mass General http://www.bostonglobe.com/metro/20...regan/4fttzx4spJ8SRA8GQLAWuI/story.html?pic=9 Notice his stump in the bottom pic, despite some discoloration it looks like it's healing nicely and probably pretty far along in his stay. Which is great because in order to get transferred to rehab you need to be well healed.

However, notice the stump in the top picture where he is supposedly getting physical therapy at Spaulding. His stump is no longer healthy, in fact the color can only mean one thing, gangrene. How did his well healed stump turn to gangrene? And if it is truly gangrene, why would they release him from the hospital, it's kind of an emergent situation he could get septic and die- you take him to surgery, you don't do physical therapy on an amputee with a gangrenous stump.

Mod: the black is the foam dressing used in negative pressure wound therapy:
https://en.wikipedia.org/wiki/Negative-pressure_wound_therapy

Also notice it's covered in plastic with a tube coming from it, pretty sure that's "vacuum assisted wound closure" therapy VAC, where it produces negative pressure or suction to help certain wounds heal. The only problem is VAC is contraindicated in gangrene, you have to debride all the black dead tissue away before can use VAC.

Mod: See above, VAC is Negative-pressure wound therapy

Also notice the large tube sticking out of the bandages on the left, again he would not have released him and be doing physical therapy on him if he had kind of seeping infected wound requiring such a drain! I can't even imagine what it's supposed to be draining, he had severe burns, but even if they were fresh and seeping you dress them you don't stick a giant tube to drain burns. The only thing I can think of that would require such a tube would be if he had an infected surgical wound of some type, which makes no sense if he's in rehab.

Mod: It's the same tube going into the NPWT

One more thing that does not make sense, in the second picture he has a nasogastric tube in. NG tubes have limited applications- to feed patients food or drugs because they can't swallow for some reason, or to decompress the GI tract in a patient with bowel obstruction and things are back up the wrong way. In the latter case the patient would likely be in severe pain and on his way to surgery, not sitting comfortably in bed. So why does he have a nasogastric tube? Am I missing something? I can provide links for any of the above, first post not sure what I need to substantiate with links, in this post the pictures pretty much speak for themselves.

Mod: There are multiple reasons, see below.
So you agree that he has an open wound on his stump because if was pretty much healed as it is shown in my second pic, he wouldn't VAC. So how did he go from the hospital with a closed almost healed wound, to an open wound when he went to rehab. You are also stating that the purpose of the tube on the left is for VAC, so you are saying he also has on open wound on the left leg. There are no good pre-rehab pics of his left leg that I could find, but doesn't make a lot of sense that after at least 45 day of hospital treatment he would still have an open wound requiring VAC to help it close.
 

deirdre

Senior Member.
But the picture of him in the hospital I posted shows that he did not have an open wound and it was almost healed, therefore no need for VAC therapy. Can you find me a link that shows there is a role for VAC in a closed healed wound as the picture clearly shows before he went to rehab?
i think its because his leg is at totally different angles. In therapy we are looking at the back of his leg...you can see a wound just below the "suture" line.
snip.PNG







and he did use it in the hospital as well, he just doesnt have it on in your pic. This photo is May 6th.
mf.PNG
http://www.gettyimages.com/detail/news-photo/jen-regan-fianc%C3%A9-of-boston-marathon-bomb-victim-and-news-photo/168297894
 

Cotran

New Member
Pardon me, I'm totally new to this...but can we start with a good source that establishes that V.A.C. therapy
"...is only used for open wounds"

I'm looking at sources like this (that don't seem to be saying that)
http://www.kci-medical.ie/cs/Satellite?c=Page&childpagename=IE-ENG/KCILayout&cid=1229625354049&pagename=IE-ENGWrapper

From you link they are saying that: "They are intended to create an environment that promotes wound healing by secondary or tertiary (delayed primary) intention by preparing the wound bed for closure..." . Secondary and tertiary wounds are open wounds. http://woundeducators.com/three-types-of-wound-closure/
 

NoParty

Senior Member.
From you link they are saying that: "They are intended to create an environment that promotes wound healing by secondary or tertiary (delayed primary) intention by preparing the wound bed for closure..." . Secondary and tertiary wounds are open wounds. http://woundeducators.com/three-types-of-wound-closure/
Thanks for the response. :)
Yes, I definitely get that they were initially designed for secondary or tertiary wounds...which are open,
but I was asking if there was a solid source to support your "...only used for open wounds" assertion.

The National Center for Biotechnology Information for instance, has this comment on a 2012 abstract:

"The success of negative pressure wound therapy (NPWT; V.A.C.® Therapy; KCI USA, Inc., San Antonio, TX)
for open wounds has been well documented and has led to its use over clean, closed surgical incisions."

(http://www.ncbi.nlm.nih.gov/pubmed/22727138)

Again, definitely not my area of expertise, but I found numerous seemingly credible statements to this effect.
 

Cotran

New Member
Thanks for the response. :)
Yes, I definitely get that they were initially designed for secondary or tertiary wounds...which are open,
but I was asking if there was a solid source to support your "...only used for open wounds" assertion.

The National Center for Biotechnology Information for instance, has this comment on a 2012 abstract:

"The success of negative pressure wound therapy (NPWT; V.A.C.® Therapy; KCI USA, Inc., San Antonio, TX)
for open wounds has been well documented and has led to its use over clean, closed surgical incisions."

(http://www.ncbi.nlm.nih.gov/pubmed/22727138)

Again, definitely not my area of expertise, but I found numerous seemingly credible statements to this effect.
Interesting, but if you read the entire article it's all patients in immediate post operative period, not 45 days later. But apparently I've already been debunked lol. http://europepmc.org/articles/PMC4199398
 

tinkertailor

Senior Member.
I just find it odd that they would need to force feed him, he looks a little too well nourished that they would have to resort to that this late in his recovery- but I could buy it being a morphine NG feed, possible. But the pic below
It could certainly be a morphine feed but it is not at all unusual for someone to be fed with an NG even when they look "well nourished". I've had plenty of experience with NG tubes, had one in for 2 months while being hospitalized for an eating disorder. The doctors didn't take it out when I started gaining weight. Tubes stay in during the day and patients can eat normal food but during the night they have a formula or nutrient drink like Ensure or Jevity pumped through. My tubes were kept in even when my oral intake was sufficient, as insurance in the event that I had a slip or lost weight.
Regarding him looking "well nourished": what makes you say this? I've known a lot of people with eating disorders or who have just been sick and it's surprisingly rare that I see someone whose condition matches their external experience. He probably was well-nourished. He came in to the hospital presumably fairly well-nourished ad that might have been sustained through the NG.
There is nothing odd about this. Extreme pain makes the appetite go down, as can pain medication.
 

Cotran

New Member
When was his last operation?
Yes you already asked that, I don't believe that is something that can be gleaned from the internet from my search for that answer. So your point is he may have had a recent operation that created a new wound requiring vac when he was transferred to rehab. And the exact dates photos were taken are not available as far as I can tell from the Boston Globe- but clearly if you read the captions and believe the piece, the top photo I posted was definitely from Spaulding and the bottom from Mass General. Thus you can see my point. But I'm willing to let it rest, and admit I have been debunked- for now ;-) It was interesting.
 
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