Thursday, May 6, 2010

Update. Again.

So, you may remember that just over a week ago, I posted a link to this picture (as well as several that were a little more graphic):

Well, the surgeon I was seeing at the time (Dr. T.) was not impressed. He felt that despite several negative swab cultures, there was clearly a "creeping infection" in my skin. He said the only thing to do was to remove the dying flesh, as well as a a "fair margin" of healthy tissue, and then keep me in the hospital until he was certain things were healing. I had the surgery on Wednesday. I was warned by the anesthesiologist that evening that the "defect" was a lot bigger than Dr. T. and I had discussed. I was thankful for the warning - the next day during dressing change, I was shocked to see a hole twice as big as discussed.
I stayed in the hospital until the following Monday, recieving intravenous Timentin. I was discharged grudgingly when I requested that I either be transferred or released to seek a second opinion. A special sponge containing silver was applied with my wound V.A.C. and I proceded to have an allergic reaction to it. A LOT of diphenhydramine (Benadryl) later, I had my appointment in a wound clinic with an infectious disease specialist. He and his nurses spent nearly an hour picking bits of the sponge out of my leg, and then photographed the remaining defect. Sadly, the sponge enlarged it quite a bit. They reapplied the wound vac and set me up to see Dr. B. in plastic surgery the very next morning.
He took one look at the wound, had more photographs taken, and began talking about reconstruction and skin grafts. His nurse was pretty careful when applying the wound vac. You'll notice in the picture below that the wound is surrounded by something yellow and leathery looking. This is called DuoDerm. It's applied right up to the edges of the wound in order to prevent any damage to healthy skin. You'll also see some wound peeking out from underneath the sponge. That's fine - the general idea is to create an overall vaccum, and the sponge doesn't necessarily have to cover the whole wound to do so.
Unfortunately, the defect now covers a large percentage of my lower leg, as you can see in the picture below. Underneath the sponge, there is bone, muscle, a nerve, and several vessles exposed. There are some new areas of necrosis, one of which involves an abcess-type lesion in one of my shin muscles. Dr. B. has reapplied the wound V.A.C.
Because of the generalized swelling and infection, I have to keep my leg wrapped fairly tightly to promote healing to whatever extent possible. The more granulation tissue (healthy regrowth) my body can produce between now and the day I have my surgery, the better things will go.
As for the V.A.C. - it takes the yellow and green and red fluids from the wound, and sucks it at a constant negative pressure into a tube. This tube runs up my leg and out the top of my pants.
My V.A.C., which is named Slurpy, then makes all sorts of strange sounds (constantly, but especially when all else is still and quiet).
Lastly, the fluids are deposited into a canister containing a gel packet. This keeps things from sloshing around while I walk. I wear Slurpy in a pouch over my shoulder, sort of like a purse. Which I hate (purses, not Slurpy).
I am currently at home. Surgery is scheduled for Tuesday, May 11th. I will get a call tomorrow to let me know whether or not I need to come in prior to my surgery date for premedication. The latest cultures of my wound have shown a particularly resistant strain of pseudomonas. Dr. B. has to go back to the infectious disease specialists to find out if they think that IV meds during and after the surgery will be sufficient, or if they think I should come in early for IV meds.
The day of surgery, Dr. B will reconstruct many of the deeper structures in my lower leg, some of which were damaged years ago. Then the skin graft will be placed, the appropriate dressing and sponge applied to both the graft site and the donor site, connected to Slurpy, and I will wake up. I will be in the hospital for a minimum of 5 days, with the potential for significantly more given the persistent signs of systemic infection. Blood cultures were finally drawn yesterday, so the results of those should be available before surgery.
I guess that's it for my update. As always, I appreciate your prayers and well wishes. This is a battle I don't like fighting. Don't want to fight anymore, but I have to keep going. No other choice. So today, just like most days, I am entirely dependent on Christ for my strength.

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1 comment:

Janelle said...


I'm so sorry for the struggle (to say the least) you have been having with your leg the last several months. You have been in my thoughts and prayers. I have been reading your blog from time to time and always mean to leave comments, prayers and encouragement but I always seem to get pulled away from the computer before I can get to it.

I miss you at work. You were so fun to talk to.

I have faith that the Lord will put His healing touch upon your leg.

Stay strong and feel free to keep in touch!

Best Wishes,