Reconstruction: March - April 2005

04/20/05
Nikki returned to Dr. Litts today for her second checkup since the last surgery, 2 weeks ago. Her first checkup, a week ago, showed the little finger looking a lot like hamburger. Even Professor Litts had expected more healing than what he found. When the Director of Orthopedics, Hand & Upper Extremities is surprised, so am I.

Today, the pinkie was obviously healing up, and was in better shape than last week. The ring finger was looking really good, with almost no sign of trauma- except for the metal pin sticking out of her knuckle. Her permanent dressings were removed, the fingers cleaned with peroxide, and light dressings were applied. Now we change the dressings twice daily, washing with soap, water & peroxide each time. The light gauze will adhere to the wound, providing some debriding (removing dead tissue) each time it's removed. This will greatly speed up the healing process, and help with scarring. Nikki was also fitted with a plastic splint along her forearm and last two fingers, to shape and protect the fingers. This splint will be gradually adjusted to increase the curl of her fingers as they heal.

A funny thing happened during the 2-1/2 hour appointment today. Nikki needed a new prescription for pain medicine- especially after they finished scrubbing and bending the poor, raw-looking pinkie. Since it would take a bit to get to Dr. Litts, we went down the hall to have her splint made. While we were there, the doctor sent some young medical assistant down to the hand clinic with Nikki's prescription. The young thing saw a bunch of people in the area, and not knowing Nikki, called her name. Some elderly woman answered that she was her, and the assistant gave her the prescription. We found this out when we went back to the doctor's office to get it. By then, the woman was gone. Much embarrassment, to be sure. They figured out who the woman was, and were planning to call her.

In other news, Nikki has been approached a few times by the nurse practitioner of the burn unit about helping OSU start up its burn support group again. When I worked at OSU in the 70's and 80's, the burn program was very robust, with a very active support group. Sometime in the years since, the program diminished, becoming a part of S.I.C.U., and the OSU support group went away entirely. The nurse practitioner was quick to notice Nikki's great, outgoing personality, and also the fact that she's handling her situation very well. The nurse has been trying to jump-start the support group for some time, and thinks that Nikki will be a huge help. Nikki is very interested, and is going to pursue this further.

Also today, Nikki ran into the Director of Physical Rehab for OSU, the guy that runs the nuts-and-bolts side of physical medicine. Bob has a strong interest in burn therapy, and has been instrumental in designing Nikki's rehab program. Bob has a series of in-house lectures coming up about the needs of burn patients next month, and wants Nikki to join him. As he said, he can speak about burns and special needs until he's blue in the face, but coming from Nikki, the words will have a real impact. She will also serve as an example that being burned doesn't have to ruin your life, as long as you don't let it. Nikki agreed to help, and will be working with Bob in the near future. Of course, I'm very proud of her involvement in all of this, and will keep everyone informed. Nikki and I agree that she should take advantage of her time away from work and other commitments to get as involved in burn support as she can.

Nikki's back to Dr. Litts next week, and I'll follow up then. Take care-

04/07/05
Nikki's 15th surgery went off without a hitch today. This surgery was performed by Dr. Litts, an orthopedic plastic surgeon specializing in the hand. Today's surgery was performed at OSU Hospital East, a smaller hospital just east of downtown Columbus. Working with the smaller hospital proved to be quite nice. For starters, there was plenty of free parking (parking at the main OSU hospital is expensive!), close to the entrance. The smaller facility is a lot more relaxed than the hustle & bustle of the 1000+ bed, 50+ O.R. suite main hospital. We arrived at 11:00am as scheduled, and Nikki was taken right in to admissions. 10 minutes later, we were taken to the surgical floor- where Nikki went straight to pre-op! There's usually long wait for this part, especially when you're not the first case. Nikki started surgery at 12:45, and went to recovery at 2:30- just 15 minutes past the scheduled time. We left the hospital at 4:30- a record for quick in and out. I'd like to have more procedures done here.

No real surprises in surgery. Nikki's little finger was a mess, as anticipated. At least two serious infections had completely destroyed the middle joint, as well as part of the bone joining the finger to the hand. Litts cleaned the remnants of the joint and diseased bone from out of the finger. He then placed two metal pins and a piece of wire into the finger, to hold it together. The finger was shaped into a relaxed, natural curl- where it will remain for the rest of her life. She will be able to flex the entire finger from the hand, but will not be able to bend or straighten the finger. This beats the heck out a permanently straight finger, or an amputated finger, so Nikki is pretty pleased. Her main physical medicine doctor, Professor Pease, has the same condition on one of his pinkies, from where he trashed it playing football as a kid. You'd never notice it, if he didn't point it out to you. The hardware can remain with her permanently, as long as it doesn't bother her, or could be removed after several months.

The ring finger is in better shape. Litts performed releases on skin and tendons, making the finger straight for the first time since her accident. A metal pin was placed in the finger, to keep it straight, and will be removed after six weeks or so. Physical therapy will then begin on the finger, in an attempt to restore normal range of motion. It's not sure yet how much motion will be regained. One complication- after straightening the finger, there wasn't enough skin to re-seal the finger. After being curled for 8 months, the skin had contracted so much that it wouldn't cover the straightened digit. So Dr. Litts took a small piece of tissue from the outer edge of her hand to graft over the finger.

Nikki is home and very comfortable tonight. She has a huge bandage over her entire hand and an ice pack over that. This will all come off next week. Her arm is still numb, so she's carrying it in a sling, to keep from banging it into things.

So- all's well, and Nikki's happy. Her next procedures will probably be more releases on the right arm and shoulder, which means the oh-so-fun airplane splint again. She's *not* looking forward to that thing again. Nikki is also considering returning to Cleveland to consult with the plastic surgeon there that did some great early work on her face and forehead. She's been in touch with him, and Cleveland is eager to see her again.

More later- thanks for reading.

04/05/05
So sorry about the long delay between updates. March was a busy month for us in general, although not so much for Nikki. My wife & I went to Florida with granddaughter Erika for a national cheerleading competition at the end of the month, and we spent a good deal of time preparing for that. Nikki didn't make that trip with us, not really feeling up to a long time away from home, and also cautious about the sun. One of the biggest lifestyle impacts to Nikki is having to avoid the sun for the rest of her life. She's always been a big sun-worshipper, sporting a deep tan every summer. Unfortunately, her grafted skin can't handle this anymore, so she has to be well-protected to venture into the sun. Her paper-thin skin will crisp in an instant, and it can actually damage the grafts.

Some bad news shortly after my last update. Nikki's last skin graft to her face, which looked good at her first postop checkup, did not take. It turned into a thick, black scab & flaked off of her face. She was very disappointed about this, until I pointed out that this was the first procedure in 14 to not work properly. Of course, this is a risk with every grafting procedure, but it's still disappointing when it happens. This was also a full-thickness graft, instead of the very thin split-thickness grafts that are commonly used. Instead of shaving off just the outer layer of skin for transplant, the surgeon digs down deep, removing all layers of skin at the site. This is a more traumatic procedure, leaving a standard surgical incision in it's place. These grafts tend to look better, due to all of the supporting layers of tissue being moved along with the outer dermis. They don't contract as easily, and they also present a smooth, sheet-like appearance after grafting.

Nikki's surgeon, Dr. Gordillo, will be waiting for several weeks before attempting this graft again. It will probably be a split-thickness graft next time, without the perforations usually used to increase the surface area. Right now, Nikki's face looks like she had a major trauma to the right side- which she did, of course. She's not very shy about it, even though she attracts a lot of attention when she goes out. The next face procedure will probably include her nose, as well. since they couldn't get to it last time. The bridge needs to be narrowed some, and the nose needs to be shifted over a little bit.

Before then, though, Nikki will be having surgery on her right hand- finally!- this Thursday. You'll remember that the last two fingers on this hand have been curled into a claw since her accident, and are almost useless. Nikki went to a hand specialist yesterday, who works with Dr. Gordillo. This guy's been wanting to get hold of Nikki for some time, and we all wish he had done so a little earlier now. After X-rays yesterday, he determined that Nikki's pinky is in really bad shape. Nikki has had at least two infections in this finger over the last 3 months, and it looks like they were in the joint itself, rather than in the soft tissues around it. Result?... the joint seems to be destroyed, and almost certainly can't be made whole again. The doctor (I can't remember his name) will open the joint, clean it out, release contracted skin and muscle on the finger, then insert a large metal pin to hold the finger straight. After 6 - 8 weeks, the pin can probably be removed. The goal is to get Nikki's finger straight again. However, it almost certainly will never be really functional.

The ring finger isn't in as bad a shape, although the muscle has atrophied significantly from being permanently curled for 8 months now. The doctor will perform several small releases on this finger, as well, and also attempt to stretch and re-attach muscle tissue where he can. He'll then start Nikki on a robust therapy regime for the hand, to force the muscle to grow & strengthen. He expects to get this finger at least partially functional, although more surgeries may be needed.

Other than these items, the last month has been uneventful. Nikki continues to socialize heavily, always on the go with friends. I think that her mental health is excellent, and her attitude very good. As I mentioned, hand surgery is this Thursday, and I'll be updating everyone afterwards. This one will probably be outpatient, with Nikki awake through the whole thing. She's nervous about this, but I've explained that she won't feel a thing, and doesn't have to watch.

More later!

03/09/05
Just a brief update tonight. Nikki has visited both Dr. Gordillo (general plastics) and Dr. Katz (oculoplastics) over the past few days. Good news from both- everything looks good. Gordillo removed about 100 stitches from Nikki's face (over an hour's work!), and it's looking good. Her grafts are still a very deep red, but are starting to lighten- a sign that they are taking. Katz removed a few stitches from right around Nikki's eye, and his work there is looking *very* good. He made it clear, though, that there's more to do, and Nikki seems ready for it.

One problem that she has is a leaky right eye; the bottom lid doesn't trap tears effectively, and they just run down her face. This may be a life-long problem for that eye, although Katz thinks that a little re-designing can mitigate some of it. We also still don't know how well Nikki's eye is working. She doesn't have any peripheral vision, and her vision in that eye seems dim and blurry. Katz said it'll be a while before we get into that, as we have to get the tissues around the eye in better shape first.

More surgeries yet to come in the not-too-distant future, and I'll keep everyone up to date. There's a couple of new pictures on Nikki's blog, of Nikki and friends. Nikki is also considering allowing some pictures of her injuries and repair work to go up there, but she's concerned about grossing-out some folks.That's all for now- more later.