Reconstruction: March 2006

03/31/06
Well, it had to happen sooner or later… Nikki is now (gasp) DRIVING again! Scared?.... you bet. Not her- ME! Nikki has always been a poor driver, because she's so easily distracted. Eating, drinking, cell phone, friends- all take her attention away from the road. Add to that her last accident- well, it'll take some getting used to. Of course, she's thrilled. After being dependent on other people to get around for so long, it's hard for her to believe that she's independent again.
Nikki is also at the end of her medical leave, returning to work this weekend. She's felt well enough to work for weeks, but she had to wait for her facial wound to completely heal. Being in foodservice, seeping wounds are generally a no-no. Now that she has the added expense of a car & insurance, she really needs to get back to work. It's good to see her so excited again.

No surgeries are planned as of yet. Stay tuned, though- they're coming. That's all for now- take care until next time.

03/13/06
Of course, Nikki made it home just fine last Saturday, with little to no discomfort. She went right to her own apartment, and has been hanging out & taking it easy this past week.

The surgical results are still 'iffy'. At least a part of the graft did not take- a small piece back near her ear actually came off. Nikki's used to bits and pieces of her falling off from time to time, but it doesn't make her happy. She's been giving some thought to consulting another plastic surgeon, since she seems to be having a lot of trouble getting the face right. The right eye looks great, though.. the "Z-plasty" really did the trick, leaving Nikki with a perfectly almond-shaped eye.
While Nikki mulls over her next step, she continues to heal. Dressing changes get easier, and the area covered gets smaller. She'll be resuming physical therapy this week, and is looking forward to getting back to work. More when we know what's next.

03/02/06
Yeah, I'm still running behind, but I have good intentions- honest! March 1st was here before I knew it, & yesterday was once again spent at OSU Medical Center. Nikki spent 3 hours in surgery, twice as long as scheduled- an error in the schedule. Time wasn't allotted for Nikki having to be flipped over during the procedure. She started out face down (although she doesn't remember it), so that Dr. Gordillo could remove the first graft from her skull. A 4 x 4 square right at the back of her head was shaved, then the split-thickness graft was harvested. The heavy hair that Nikki has re-grown since her accident will hide this nicely.

Nikki was then flipped over on the table (it takes a lot longer than you'd think), and a sizable chunk of skin was harvested from her left thigh (a favorite donor site, since her right leg was burnt some). Then the Acticoat & Integra was removed from her last surgical site, exposing raw tissues. This area was a little "soupy", probably from mild topical infection, so it was thoroughly cleaned. Then the skin from her skull was grafted onto the upper face, around the right eye. This skin type is almost identical to the skin that grows on the upper face, making for a natural look after grafting. The skin from her thigh was then slightly meshed (tiny holes punched in it to make it cover a wider area), then grafted to the upper neck & shoulder. As of now, the site is very clean looking, with a very snug WoundVac clinging to it like a black jellyfish.

Nikki also had a "Z-plasty" performed on the inner corner of her right eye. This part of her eye has had a squared-off look ever since plastic surgery done in Cleveland just after her accident to rebuild the area. Gordillo made a Z-shaped incision, which seems to prevent tissues from lining up in a manner that enables contractures…. sort of contracture-proof, as it were. Gordillo then reshaped that area around the eye, making it more almond shaped. We can't see this now, as she has a bandage over the eye, but we're all excited to see how it came out.

Gordillo had already decided yesterday morning that she wanted Nikki to stay at the hospital for a few days with a WoundVac, instead of going home as originally planned. She had problems getting a room, as there were no beds on the surgeon's favorite units. Nikki spent 7 hours in recovery, while room was made for her on the desired unit. My wife & I came back to visit her at 7:30pm, running an hour late, and she had just gotten to her room in the last 10 minutes. She was wide awake & feeling alert, although she had her usual post-op nausea. No solid food that night. Nikki will be discharged on Saturday.

Gordillo plans to focus some really aggressive physical therapy on the right side of Nikki's face & neck, in an effort to ward off contractures. The graft was done in two pieces for the same reason, instead of using long, single sheets, which is what has been done in the past. This is the third time that Nikki's face has been re-grafted due to contractures, and we'd all like it to be the last. If successful, this should be the last major procedure on her face.

Future procedures will concentrate on the right arm- elbow and shoulder. It's possible there could be some more surgery on the right hand, but that's far from definite. Nikki is also thinking about trying to do something about the "ledge" that formed at the juncture of her back and hips when all of her soft tissue on the back was burned away in her accident. This left her hips sticking several inches out from her back, like a ledge. Just after the accident, I could lay all 5 fingers of my hand flat on this ledge, and a little still peeked out- all raw tissue on top. As Nikki lost weight in the hospital, this ledge actually healed over and joined back to the back- an amazing thing to watch happen, believe me. But now, Nikki's waist is much smaller than her hips, making fitting clothes difficult. Her back also has no cushion anymore, as all fatty tissue was destroyed. As a result, she's not padded well right where pants & aprons tend to clinch, and it hurts. It also wears skin raw sometimes, which could get infected. Dr. Gordillo is already thinking over the best way to deal with this. One thought is to take fatty tissue from a thigh and surgically place it around the waistline at her back. Nikki wishes she'd just suck some from her ample butt & move it up a bit. In any event, this is low-priority stuff, and may not happen for some time.

Stay tuned, and I promise that I'll update everyone after she comes home Saturday.