Reconstruction: February 2005

02/26/05
Surgery 14 on Friday 2/25/05 was a success, although not everything that was planned was completed. We got to the hospital at 5:30am, for a 7:30am surgery. Then she was bumped 1-1/2 hours due to an emergency case for Dr. Katz. She finally started at 8:45am, and was in surgery for exactly 6 hours, with two plastic surgeons working on her in tandem. She then spent 2 1/2 hours in recovery, having some problems with low blood oxygen. They finally got that stabilized, and she got to her room at 5:30pm. She was in a great deal of pain last night, but was feeling much better today... *so* much better, that she wanted to come home! The doctors agreed, and Nikki got home at 4:00pm today. As soon as she got here, she threw up- the car ride usually bothers her after surgery. She's now laying on the couch reading & watching TV. She has pain in her face, of course, but it's manageable. She also has pain on her stomach, where the donor site is.

Dr. Gordillo, the general surgeon, did a *lot* of work on the skin on the right side of Nikki's face and neck, Several releases (removal of hard, contracted pieces of skin) were performed on the right cheek, neck, nose and underneath the right eye. These were then grafted with skin from Nikki's left neck, behind the left ear, and from the abdomen. These were full-thickness, sheet grafts- fairly thick, with no perforations. This type of grafting, although not an economical use of skin, provides the smoothest look afterwards- just what you want for the face. After repairing that, Dr. Gordillo basically grabbed the right side of Nikki's face and pulled it upwards, stitching it in place (she made it sound like lacing up a pair of boots). This relieved the drag of the skin around the right eye and nose. Stitching followed the jaw line, just underneath it, in order to be nearly invisible after healing. Stitching also had to be done inside of Nikki's mouth, through the cheek, in order to keep everything in place.

Dr. Katz, the oculoplastic surgeon (an ophthalmologist with a residency in plastics) led the repair work around Nikki's eye. First, it was determined that there was more tissue available around Nikki's lower eyelid than suspected. Katz didn't need to transplant a piece of cartilage there for support, as originally planned. Apparently, the great plastic surgeon in Cleveland had already laid the groundwork for this procedure, 'way back in September. Katz spent a lot of time reshaping the tissues around the outside of Nikki's eye, for a more pleasing appearance, and better function for the lids. The outer corner of Nikki's eye has been squared-off since her accident, instead of meeting in a corner, as is normal. He also decided the bones around the eye didn't need any work for now. Although they've healed in a jumble of pieces, they're functional, solid and not causing any problems. They also look OK on the face. Instead, Dr. Katz worked with the tissues that support the eyeball, delicately moving them around, and therefore, moving the eye slightly. He got the eye close enough to where he wanted it, without major trauma to the face, and was very happy with the results. His attitude is that "good enough is good enough", and he can always go back in later with a hammer & chisel if needed (shudder). We can't see *any* of her eye now, due to the bolsters (rolled bandages, sewn directly into the surgical area) attached to it. One long suture goes from the lower eyelid up to her forehead, pulling the eyelid up with it. All of this will be removed on Tuesday, four days after surgery.

The nose did not get done, other than to have a release done to contracting skin on it's side. Both doctors were exhausted after 6 straight hours of very detailed work (Gordillo looked like she had run a marathon- sweating, disheveled), and the nose would have meant another 2 hours of work for her, and 2 more hours of anesthesia for Nikki- neither of which was desirable. Gordillo plans to do the nose in 2 months or so. Nikki will also need releases done to the right armpit again, probably in conjunction with her right finger work. She'll also need a release on the left armpit. That's at least 3 more surgeries in the foreseeable future. Nikki's hoping she can reach 20 surgeries by late July, one year from her accident. What the heck, everyone needs goals....

Back to see Dr. Gordillo on Tuesday and have the bandages removed. She'll also see Dr. Katz sometime next week, and get the preliminary results on all of this work. I'll follow up with everyone then. Thanks for all of the supportive messages that we've received. Nikki reads all of them, and they mean a lot to her. Take care for now.

2/22/2005
Nikki made a trip to the doctor a day early yesterday, when one of the two deformed fingers on her right hand suddenly swelled up and burst open at the middle knuckle. As you might guess, this hurt A LOT & scared hell out of Nikki. The doctor calmed her, telling her she just had a general infection in the soft tissues there, and that antibiotics would clear it right up. Nikki was afraid that this might interfere with the surgery scheduled for Friday, but no problem there. The doctor went ahead with her pre-surgery meeting, since everyone was there.

We've got some specific goals now for Friday's surgery. This one will focus a lot on looks, not just functionality, making it really important to Nikki. Dr. Gordillo will perform some tissue releases on the right side of Nikki's face, just behind the eye and down on her lower cheek, and also on her right neck. Skin will be taken from the left neck to fill the releases on the right. They may also shave behind the right ear and take skin from there, since skin from these areas is the best match for her facial work. Next, her nose will finally be fixed. Nikki's nose was smashed flat against her face in her accident. It was given basic (but very good) repairs while in the emergency room, so that she could breathe through it later. However, it's a little misshapen, and always sort of pulled to the right side since her accident, and she'd like to get it back where it belongs. The bridge is also still flattened out, and needs to be brought up to more of a defined ridge. There'll be some grafting here, too.

While the nose is being fixed, a piece of cartilage will be removed and used to rebuild the lower right eyelid. There's only two types of cartilage in the body suitable for contact with the eyeball itself, and the nose has one of them. This will be attached to the muscles that control the bottom eyelid, giving the eyelid support & muscle control once again. This will enable her right eye to close completely for the first time since her accident.

Finally, Dr. Katz (oculoplastics) will do the eye work. He hopes to use existing tissue to relocate the eyeball to it's proper place. Any bone repair around the eye will be kept to a minimum. The orbital may be healed in pieces, but if it's working, he's going to leave it alone. The eyelid and eyeball work is extremely delicate, and will take a goodly part of the 6 - 8 hours planned for the surgery. It involves precise measurements of the eye's location (in millimeters), including in relation to the other eye. The eye and optic nerve will also get a good exam, to confirm the amount of permanent impairment to her vision.

No work will be done on Nikki's hand at this time. There's a hand specialist in Dr. Gordillo's practice that's itching to get hold of her hand, but that'll have to wait for another time. As of now, Nikki still can't use the last two fingers of her right hand (and she's right-handed). There may also be more work needed on Nikki's right cheek in the future, both skin and underlying bone structure. The bones there were crushed, but healed pretty well.

Other parts of Nikki's life continue to go well. Physical therapy continues to make good improvements to her functionality. Her Social Security Disability has kicked in, with a fairly large monthly payment, along with a large back payment of benefits. Medicaid's disability supplement is now discontinued- indeed, she had to repay all such benefits that she has received to date, out of her social security. Unfortunately, Nikki now has to pay for her Medicaid medical coverage out of her monthly disability check- about 1/3 of it. That's pretty steep, but she will need that coverage for some time to come.

We have to be at the hospital at 6:00am Friday, as she's first case. I'll get an update out sometime during the weekend. Stay tuned!

2/2/2005
Nikki has been scheduled for a major surgery on the 25th of February. The final details aren't nailed down yet, but it's anticipated that this will be her big facial repair. Involving her general plastic surgeon (Dr. Gordillo) and an oculoplastic surgeon (Dr. Katz), the general goal is too repair all of the facial fractures, including both orbital sockets. Attention will also be given to improving the structure of her right eyelid, with the goal of getting it to close completely & losing the plastic moisture barrier that she's worn since her accident. Rough estimates are 6 - 8 hours in surgery, involving both surgeons the entire time.

Rather than peeling her face down below the fractures, as originally envisioned, multiple fine-line incisions will be made above and below the damaged areas. It may also be necessary to go through the roof of the mouth for the right eye socket repair and re-positioning. Doesn't that sound like fun? Nikki is *very* gung-ho about this, and seems to have no fear at all. She's been pushing to get this done for some time, and is happy to finally have it scheduled.

Nikki went through a lot of disappointment over the failed tissue expander & the damage that it caused to her forehead. That failure, along with some personality issues with the surgeon that performed the procedure, led to her leaving that surgeon's care. Her regular surgeon, Dr. Gordillo, has been very supportive of Nikki, and agreed to do her facial work herself, with Dr. Katz doing the eye work. Nikki loves Gordillo, and has met & liked Katz, so she's very happy with the way things are progressing now.She has a couple of planning sessions with doctors before the big day, and I'll keep all of you informed as the procedure is better defined. More later!