We finally reached the day that we've been waiting for. The day that his foot would be put together completely so he could start healing and work towards walking again.
This morning at 5:30 a lady from the plastics team came by to explain what was going to happen today. She shook me awake and then started talking a mile a minute so it was hard to follow. I kept hearing flap and graft these last few days which I didn't know the difference between the two, if there was one. This morning she mentioned something about his latissumus dorsi and why it was the best muscle to use which I hadn't heard anything about yet so i was trying to follow. So it finally clicked and the only thing i got out of everything she said was that he was going to have two separate donor spots which bummed me out. Once we got down to pre-op questions were answered and things were explained.
(I may not explain it exactly right but enough for you to follow)
A skin flap is when they get under your skin and take muscle. They were planning on the lat muscle which would mean he wouldn't have that muscle anymore and the other muscles around it would compensate for it but if he wanted to do weightlifting or rowing in the future it would be a challenge. Once in his foot it wouldn't be a functioning muscle but will act as the tissue that he lost. It's to give him the cushion needed for his foot to support his body weight. He would then have to wear a drain for 2 weeks.
A skin graft is when they "shave" a paper thin layer of skin off your thigh (or other part of the body) to cover the opened wound. Simple enough I guess.
I don't know if it's for both of these procedures or just the skin flap but he would have to stay in a "tropicana" room (a room that stays around 80 degrees) so the blood vessels (or whatever) can stay opened for good blood flow and quicker healing...something like that.
They were also going to try and save the PNC (nerve catheter) because it was leaking and losing its effect.
They told us that it was going to be an 8! hour surgery. Yikes! I think I've said it before that the waiting and not knowing is the hardest part of this whole journey. To wait for 8 hours would be crazy. I would go insane! So we left the hospital to go get food and to get some fresh air since I've been in the hospital for two weeks straight now. It felt really good to walk in the sun. We walked for about a half hour and right before ordering food we got a call from the surgeon saying that they weren't going to do either flap or graft today. As soon as they unwrapped his foot they saw that he was growing new tissue, his dermis layer, so he wouldn't need the muscle anymore for that cushion in his foot. Instead they put something in called Integra...
What is Integra®?
Integra® is an artificial substance that contains no living components. It is not designed to be a replacement skin. Rather, Integra® supplies a protective covering and a pliable scaffold onto which a person’s own skin cells can regenerate the lower, dermal layer of skin destroyed by burn.
What is Integra® made of?
Integra® consists of two layers, just like living skin. The bottom layer, which is designed to regenerate the lower layer of real skin, is composed of a matrix of interwoven bovine collagen (a fibrous cow protein) and a sticky carbohydrate (sugar) molecule called glycosaminoglycan that mimics the fibrous pattern of the bottom layer of skin. This matrix then sticks to a temporary upper layer: a medical-grade, flexible silicon sheet that mimics the top, epidermal layer of skin. Integra® looks somewhat like translucent plastic wrap.
How does artificial skin help a burn victim?
After first removing tissue destroyed by a severe burn, a burn surgeon drapes Integra® over a wounded area of skin and leaves it there for two to four weeks, during which time the burn victim’s own cells climb onto the matrix and grow a new dermis. Surgeons then remove the top layer of Integra® and apply a very thin sheet of that person’s own epithelial cells. Over time, a normal epidermis (except for the absence of hair follicles) is reconstructed from these cells.
...they talk about burns but it's the same for Kainen's type of injury.
So he will be here in the hospital for 2 weeks on a wound vac and then we'll go back in to do the skin graft. At that time we'll see if the Integra worked or if there's any tissue that still needs replacing. After being stitched up he'll have a cast from foot to mid/upper thigh and we'll finally be able to go home. So the day we've been waiting for didn't come yet but things are working out in our favor and, to me, that's all that matters.
Did you get all that? If you have any questions just ask. There's so much to follow it's hard to keep up.
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