Reconstruction: October 2004

10/23/2004
Nikki had surgery yesterday, to release contracting skin grafts on the right side of her neck. The surgery went well, with no complications. Nikki did have a long recovery- 2 hours. This was due to a low body temperature (something that plagued her in Cleveland, too), and high levels of pain immediately post-op. Both were eventually controlled, and she came through fine.

There was a change in plans, though. Instead of being able to go home last night, or even this morning, Nikki is in the hospital until Monday. The procedure involved removing a fairly large area of skin grafts- about the size of two hands. Grafts were removed from her right neck, the back of her neck and underneath her chin. The excision was pretty deep, leaving a large wound. Over this, Dr. Gordillo placed Integra, an advanced bandage/skin substitute, often used in burn patients prior to actual skin grafts. The Integra protects the wound much like skin does, promoting healing. It also doesn't contract, the way skin grafts do. Over this, a device called a Wound VAC was placed, too stimulate blood flow in the surgical site..

The Wound VAC was created at North Carolina's Wake Forest University back in 1995, and has been increasing in use, especially in burn patients. We're lucky enough to have a senior member of the wound care team at OSU that actually worked with the development of the VAC, who is overseeing its use on Nikki. In certain cases, the VAC has improved the success rate of skin grafts from 60% to near 95%. Neck grafts are difficult at best, so every advantage is important.
Nikki seems a little depressed to be back in the hospital again, but she's still excited to be working on things that will enhance her appearance. Since she's going to be at OSU through Monday, I'm hoping that her orthopedic surgeon will come see her there, in lieu of her Monday morning appointment. She's also scheduled to continue measuring and fitting of her compression garments on Monday, hopefully while she's still an inpatient. Later next week, Nikki is scheduled to meet with the plastic surgeons that will be doing the repair work on her eye and the surrounding areas.

Nikki's health insurance will expire at the end of this month. After that, we're at the mercy of her pending Medicaid application. Fortunately, OSU and its affiliated doctors and clinics will accept "Medicaid Pending" as a provider. Nikki's burn garments will probably be paid for from the OSU Burn Fund, a charitable fund provided to those who need it. The compression garments are very expensive and even Medicaid has a long and difficult approval process for covering them. The doctors don't want this to be delayed, so they've arranged to tap the fund for her.
Overall, Nikki is progressing well. Her skin grafts, which have been a deep, leathery red color are already lightening up and becoming soft, more skin-like. Her sensitivity has been increasing, to where she can feel almost normally in all of her burn areas. The burn garments will enhance this process.

I'll update again next week, after Nikki's discharge and visits with her other doctors. Stay tuned!

10/19/2004
My first update in a while, since Nikki's discharge in September. We've all been concentrating on getting back to a "normal" life, and enjoying it thoroughly. Nikki is mostly self-sufficient now, able to eat, dress herself and so forth. We're not comfortable leaving her alone, so we usually drag her along with us whenever we leave. I'm back to work now, although not in the same position that I held before. No complaints- I took the chance, did what I thought was right, and wasn't affected financially in the long run.

Nikki continues to do well. She has occupational therapy twice weekly, about 90 minutes each time. Work is focusing on her right hand, both elbows and shoulders, and on her neck. Two fingers on her right hand were originally curled into a claw position, due to contracting skin grafts. Through the use of splints and casts, these fingers are nearly straightened now. Range of motion in her left elbow and shoulder has greatly improved, while the right arm is going much more slowly. The right side of her neck is also contracting steadily, pulling down the right side of her face and her damaged right eye. The OT clinic is also handling the measurement for and fitting of pressure garments for all of her grafted areas. This is a slow process, as the garments are custom-made.

Home health care continues to visit and do her dressing changes. These become simpler as time passes and the wounds heal. Now, Nikki only needs the wounds at the base of her back / top of her buttocks wrapped. It's a challenge to keep this area wrapped, as Nikki is pretty active, constantly working the dressings lose. She's always going shopping, or out to eat with friends or family. Last weekend, she even went to a Cleveland Browns game with her boyfriend, a long up-and-back trip on Sunday. People have been very considerate to her, engaging her in conversation and such, without a lot of staring. She had one embarrassing moment a week ago, while in a Halloween costume store for her niece. A young girl thought that Nikki was working at the store, in costume. Nikki tried to explain, but discovered that the girl was handicapped and didn't understand. The girl's mother apologized to Nikki, and explained the situation to her daughter. Nikki resolved to stay away from costume stores for a while.

Things are starting to move along with Nikki's reconstructive work. Her appointment today with Dr. Gordillo, a plastic surgeon, has resulted in surgery being scheduled for this Friday at OSU. Gordillo is going to perform a release on the right side of Nikki's face & neck. A pretty large area of grafted skin will be removed from this area and replaced with Integra, a substitute skin material. This will relieve the pulling that's occurring all along her face, eye and neck. The Integra will be in place for a few weeks, and then will be replaced by another skin graft, probably taken from the thigh. Nikki will stay overnight after this procedure.

Next week, Nikki has an appointment with Dr. Rosenberg, a cranio-facial plastic surgeon. He, along with an ocular plastic surgeon, will begin plotting the reconstruction and relocation of Nikki's right eye. As mentioned before, her eyeball is out of place on her face, due to the fractured socket and damaged supporting tissue. Rosenberg's specialty involves breaking the bones in her face, including the eye socket, and rebuilding as needed, while the ocular PS specializes in physically re-securing the eyeball and ensuring that it's functional. They also need to continue rebuilding the lower eyelid. It's delicate work, demanding a lot of attention to detail. The payoff will be an eye that works and looks a lot better. Without this correction, the eye won't be very useful to Nikki.

Another appointment coming up will be with Dr. Bos, Director of Orthopedics at OSU. Bos will be evaluating the heterotopic ossification in Nikki's elbows and right shoulder. This abnormal bone growth causes a lot of pain in the afflicted joints, and also restricts movement. The likely outcome here is surgery to remove the offending growths.So, after three fairly quiet weeks, it's time to get going again. Nikki is excited about the upcoming work, knowing that it's the beginning of improving her appearance, as well as enhancing her functionality. I'll probably have more frequent updates, now that stuff is starting to happen again. We still receive a fair quantity of emails, so I know that people are still interested in Nikki. Stay tuned!