Reconstruction: July 2005

07/21/05
A fairly brief update today. Nicole came through surgery 17 yesterday with flying colors. We left for the hospital at 9:30am (she was 3rd case), she went to pre-op at 11:15am, surgery at 12:31am, post-op at 1:45pm, and discharged at 4:30pm- a new record for quick surgeries! A 2" x 12" strip of skin was taken from the top of her left thigh (her most undamaged one, with the most healthy skin) and cut to fit the skinless area of her upper right shoulder and lower right neck. This area was in great shape, after playing host to Integra (an artificial skin substitute) the last two weeks, and the graft bed was perfect. This graft was not perforated to increase the coverage area, leaving the skin looking smooth and natural. Therefore, in technical terms, Nikki had a "split-thickness sheet graft". She was quite comfortable afterwards, with only a little nausea from the post-op morphine. Usually, her harvested areas hurt worse than her graft sites… after all, it's like taking a razor and cutting off the top layers of skin, leaving a very bloody "raspberry" behind, full of screaming nerves. However, this small graft doesn't seem to bother her at all, and she's been quite active.

Late August is the next tentative date for surgery. Probably a joint effort between Dr. Gordillo (general plastics) and Dr. Katz (Occuloplatics), involving more reshaping of the right eye and upper right face. Gordillo may also get into Nikki's nose repair, using a combination of artificial materials and harvested bone to reshape the bridge of her nose. Soon after that, some major releases are needed on Nikki's right shoulder and elbow, to provide some much-needed range-of-motion improvement.

Closer at hand, and more fun to think about, is Nikki's 1st Survival Anniversary! One year ago this Saturday, at 2:00am, Nikki came very close to leaving us forever. The unbelievable support of a number of great people, plus the determination and incredibly positive attitude of a very special lady, have turned a near-death experience into a life-altering event. All of you are sharing that experience with Nikki, through the imperfect window of my writing. A better writer would do the story more justice, as I feel that it's a powerful tale. Nevertheless, we'll continue to plod along together, you and I, peeking into a remarkable young lady's life as she continues to triumph over situations that would break many others.

Stay tuned for another update after this coming Anniversary!

07/09/05
Surgery 16 was successful on Wednesday 7/6/05… as a matter of fact, it went so well, that Nikki was discharged yesterday!

Nikki spent about 90 minutes in surgery, her fastest surgery to date. As planned, an area of hard, constricted skin was excised from her lower neck and the top of her right shoulder. As soon as this toughened skin was removed, Nikki's face, mouth and eyelid all lifted noticeably- just what we wanted. The results were so good that Dr. Gordillo didn't remove any skin from her face, preferring to minimize the trauma. Integra was laid over the now-skinless area, and the WoundVac (described below) was applied over that. Nikki was very comfortable after returning to her room around 11:30am. I got her some French fries from Wendy's, and left her happily munching on them. Later that evening, my wife and I brought her Chinese food, and she ate a lot of that.

We learned from Dr. Gordillo that Nikki's last CAT scan had shown some polyp growth in her right sinus cavity. You'll remember that both of Nikki's sinuses were crushed in her accident, along with her nose being smashed flat against her face & burned. The E.R. docs reshaped the nose very well, although it still has a flattened look to it. Since the skin and underlying material was seriously damaged, Dr. Gordillo is planning to use artificial materials to reshape her nose, building the bridge back up again. Gordillo also consulted with ENT (Ears, Nose, Throat) on the polyps, but ENT isn't very concerned. Nikki breathes properly and doesn't have any discomfort there, so the docs decided to try antibiotics for a while and see if they affect the polyps.

On Thursday, Dr. Litts, the hand Plastics doc, paid Nikki a visit to check out her right pinkie. This finger has never healed properly since pins were inserted into it a few months back. You could even see one of the pins peeking through her skin. So, Litts removed it…. He grabbed it with a pair of pliers and just pulled it out! You'd think this would hurt like hell, but Nikki said it wasn't bad. But then, Litts pointed out another pin- a figure-8 piece of wire wrapped around the knuckle. He said that this needed to come out, too. This time, he used some Novocain to numb the area, then worked the wire out. More painful, and pretty gross-looking, too. It was effective, though. By that evening, Nikki's swollen knuckle had reduced to normal size, and the open wound was looking much better.

On Friday, Nikki called to let us know that they were thinking of discharging her today, a day early. It was decided not to send the WoundVac home with her, since it's very difficult to get Medicaid to cover home nursing- a necessity with the WoundVac. Instead, Nikki will visit the doctor every three days at first to have the dressing on her neck changed. Then, on July 20th, surgery again to graft skin from her thigh onto her neck.

Nikki is home and feeling fine. We went to dinner last night, and she's up and active. Her right arm is in a special type of sling, keeping the arm elevated so that it doesn't drag down on the surgical site on top of her shoulder. She's already looking forward to the next surgery, and having some good-looking skin over her lower neck.

07/04/05
Rest time is over for Nikki, and it's surgery time again. On Wednesday 7/6/2005, Nikki will have another major release to the right side of her face and neck. Skin that has stiffened and hardened to a plastic-like texture will be excised- an area about the size of both palms put together. A layer of Integra, a man-made material used as a temporary skin replacement, will be laid over the now-skinless area. A WoundVac will be attached over the Integra. This looks like a small jellyfish with a hose running from it to a powerful vacuum pump. It looks like a piece of pebbled tar paper, very pliable. When activated, though, the WoundVac will seal tightly over the wound, becoming rock-hard. The WoundVac stimulates blood flow into the skinless area, including into the Integra, greatly speeding up healing in the area. In a couple of weeks, Nikki will return to surgery to have the WoundVac and Integra removed. At the same time, skin will be harvested from her thighs and grafted onto her face and neck. With the healthy tissue bed provided by the WoundVac and Integra, it’s hoped that the new grafts will take really well.

Nikki's looking forward to this one, as she really wants to get her face back together. I'll post after the surgery Wednesday and let everyone know how this one went. The last time she had this type of procedure done, it cost Nikki 3 days in the hospital. More coming up soon!