Nikki returned to work in late June, 9 days later than she originally planned. The same day that she got the go-ahead from her doctor to start working again, she stopped by Cheescake Factory to see when she could start. The two week bar schedule had just been posted, so she spent the next couple of weeks picking up hostess & serving spots. Other than sore feet, after 1-1/2 months of laying around her house, Nikki had no problems settling back in. She's been back on regular bar shifts for some time now & is doing fine.
Nikki's flap transplant continues to improve in appearance. Almost all of the dark, red lines around the edges of the graft have faded away. The actual suture lines are so small & fine, you have to look closely to see them. One small area, up near her ear, still has a red outline. This was also the slow-to-heal area that delayed her return to work. The graft continues to shrink as it settles in. It's uncertain whether surgical reduction of the flap will be needed.
That's all for now. I'll keep you informed of any updates or changes.
Thursday, July 29, 2010
Wednesday, June 23, 2010
Almost ready for work
Nikki has healed very well over the past month. The tissue flap has settled onto her neck nicely, and significantly reduced in thickness. The suture lines around the flap are still very prominent, the deep red of a healing cut. Her doctor has said within another 60 days or so, these lines will fade, causing the flap to blend in even better with the rest of her skin. The doctor has been very pleased with how her recovery has gone.
Nikki had hoped to return to work on June 19th, but she had to delay another week, due to a small open sore at the top of her flap. A very small area just under her ear healed very slowly and has only scabbed over in the past few days. She's been fully mobile for most of the past month, but an open sore in food service is a definite no-no.
Nikki would like to try to have more surgical work done by the end of this year. She'll have to juggle her finances, her job and other responsibilities before she can schedule anything, though. I'll keep the blog updated as the year moves onward.
Nikki had hoped to return to work on June 19th, but she had to delay another week, due to a small open sore at the top of her flap. A very small area just under her ear healed very slowly and has only scabbed over in the past few days. She's been fully mobile for most of the past month, but an open sore in food service is a definite no-no.
Nikki would like to try to have more surgical work done by the end of this year. She'll have to juggle her finances, her job and other responsibilities before she can schedule anything, though. I'll keep the blog updated as the year moves onward.
Monday, May 24, 2010
Home From the Hospital
Nikki was discharged and returned to her home on Sunday 5/23. Her recovery went well, with only minimal discomfort. Immediately after her surgery, her face had a dull ache all of the time, but never any sharp pain. She learned quickly, however, that she had to be careful how she moved her head. Any turning or twisting of the head put stress on the transplant, which hurt. Nikki also had trouble holding a phone in any kind of a comfortable position, so she tended not to talk long. Her leg hasn't bothered her much at all, in spite of the 10 inch incision.
Friday was a little rough for her, as she had a steady stream of visitors all day. The nurses finally told her they were concerned that she was over doing things, reminding her that she had just undergone major surgery. When we visited her that evening, she was tired, sore and grouchy, so the nurses were obviously right. Nikki finally agreed with them & warned off most of her friends for the following day, so that she could rest.
She was discharged around noon on Sunday, and her sister went to get her and take her home. She was home by 2:30pm & resting comfortably. One logistics problem at home- keeping her 90lb. American Bulldog, Reno, from jumping all over her. Reno loves everyone and gets very excited when people stop by.
Nikki won't be able to drive for a while, so she'll need the help of family & friends to make it to the doctor and any shopping needed. She is off work for 4 weeks, which always drives her crazy. Nikki likes her job, likes being active and likes being around people. Staying in her house, quietly, for a month is a real challenge for her.
I'll have more after her next doctor appointment, in a week or so. Stay tuned.
Friday was a little rough for her, as she had a steady stream of visitors all day. The nurses finally told her they were concerned that she was over doing things, reminding her that she had just undergone major surgery. When we visited her that evening, she was tired, sore and grouchy, so the nurses were obviously right. Nikki finally agreed with them & warned off most of her friends for the following day, so that she could rest.
She was discharged around noon on Sunday, and her sister went to get her and take her home. She was home by 2:30pm & resting comfortably. One logistics problem at home- keeping her 90lb. American Bulldog, Reno, from jumping all over her. Reno loves everyone and gets very excited when people stop by.
Nikki won't be able to drive for a while, so she'll need the help of family & friends to make it to the doctor and any shopping needed. She is off work for 4 weeks, which always drives her crazy. Nikki likes her job, likes being active and likes being around people. Staying in her house, quietly, for a month is a real challenge for her.
I'll have more after her next doctor appointment, in a week or so. Stay tuned.
Wednesday, May 19, 2010
Surgery #24 was a success
Up at 4:15am this morning, to be at OSU Medical Center by 5:30am... yuck. Nikki actually worked until after midnight last night and didn't get to our house until 1:30am. Of course, she got to take it easy all day ;).
She was checked in and up in pre-op by 6:00am, with surgery scheduled for 7:30am. Only one person could go with her during prep, so my wife sent me along. Nikki's surgery was actually in the James Cancer Hospital- a first. I didn't even know that the James had it's own O/R suites, but they have six of them. Dr. Miller prefers to operate and keep his patients there when possible, since most of his Plastics workload comes from cancer patients.
Nikki was once again a difficult stick- they couldn't get an IV started. Her arms are both covered with grafted skin from her burns, and this is very difficult to work with. The only suitable veins are deep ones, and it's very hard to pick them out through the scar tissue. Two nurses, a nurse anesthetist and an anesthesiologist all had a go at it... the doctor even used an ultrasound machine to pinpoint a good vein, to no avail. They finally decided to use inhalation sedation in the first round to put Nikki under, then dug around and started two IVs while she slept. Her arm is well-bruised from the efforts.
Nikki was taken to the O/R at 7:32am, although the procedure did not start until 9:00am. My wife Bonnie & I spent a long, dreary day in the family waiting area, reading & playing on our laptop. We left for lunch & snacks in the cafeteria, but didn't venture outside, since it rained most of the day.
Surgery was expected to last 7 hours; it lasted exactly 8 hours. Dr, Miller came to us immediately after, saying that all went as planned. He took a piece of tissue about the size of my hand from Nikki's left thigh, one of the few unburned areas on her body. This slab of tissue was about 3/4" thick and contained a portion of a major vein running through her leg. This vein, along with several smaller ones, was microsurgically attached to existing veins in Nikki's neck and face. It's very important that a good blood supply be maintained to this large piece of tissue, or it will fail. That, along with preventing infection, is the main reason that Nikki has to spend 5 days in the hospital. The tissue graft will be checked regularly with a sonic-amplified scope and ultrasound to ensure it's health and circulation.
We were allowed to see Nikki in her room around 7:00pm. She looked amazingly good and had no pain at that time. This is also the third time that she's had no post-op nausea. The tissue graft was completely uncovered, allowing us to get a good look at it. It's quite a large bulge of tissue, slightly lighter in color than the rest of her neck & face (her face gets more sun than her thigh). Dr. Miller said that the lump will settle and spread out some on its own as it settles in. If necessary, it can later be surgically spread out some more, or reduced through liposuction, to better fit the contours of her neck and face. The great news is that you can already see the relaxing of the grafted skin on her upper face, where it was pulled down by contractures previously. Her right lip and eye are already in better positions than they were. Her thigh is also in good shape; Dr. Miller simply pulled the lips of the wide, deep incision together and stitched them in a neat line, leaving no deep scoop or imprint behind. Her thigh will quickly replace the missing tissue.
One unusual side effect- the large piece of tissue on her neck will be dead to the touch, since nerves cannot (yet) be surgically reconnected. Over time (years), Nikki will regain some sensation there as nerves from her surrounding neck areas infiltrate the newly transplanted tissue. A small price to pay for a much better look to her face.
And that's it. After 14 hours at the hospital, Bonnie & I didn't linger long. We'll be visiting her during her stay, and I'll report anything that comes up. Thanks for following Nikki's latest adventure.
She was checked in and up in pre-op by 6:00am, with surgery scheduled for 7:30am. Only one person could go with her during prep, so my wife sent me along. Nikki's surgery was actually in the James Cancer Hospital- a first. I didn't even know that the James had it's own O/R suites, but they have six of them. Dr. Miller prefers to operate and keep his patients there when possible, since most of his Plastics workload comes from cancer patients.
Nikki was once again a difficult stick- they couldn't get an IV started. Her arms are both covered with grafted skin from her burns, and this is very difficult to work with. The only suitable veins are deep ones, and it's very hard to pick them out through the scar tissue. Two nurses, a nurse anesthetist and an anesthesiologist all had a go at it... the doctor even used an ultrasound machine to pinpoint a good vein, to no avail. They finally decided to use inhalation sedation in the first round to put Nikki under, then dug around and started two IVs while she slept. Her arm is well-bruised from the efforts.
Nikki was taken to the O/R at 7:32am, although the procedure did not start until 9:00am. My wife Bonnie & I spent a long, dreary day in the family waiting area, reading & playing on our laptop. We left for lunch & snacks in the cafeteria, but didn't venture outside, since it rained most of the day.
Surgery was expected to last 7 hours; it lasted exactly 8 hours. Dr, Miller came to us immediately after, saying that all went as planned. He took a piece of tissue about the size of my hand from Nikki's left thigh, one of the few unburned areas on her body. This slab of tissue was about 3/4" thick and contained a portion of a major vein running through her leg. This vein, along with several smaller ones, was microsurgically attached to existing veins in Nikki's neck and face. It's very important that a good blood supply be maintained to this large piece of tissue, or it will fail. That, along with preventing infection, is the main reason that Nikki has to spend 5 days in the hospital. The tissue graft will be checked regularly with a sonic-amplified scope and ultrasound to ensure it's health and circulation.
We were allowed to see Nikki in her room around 7:00pm. She looked amazingly good and had no pain at that time. This is also the third time that she's had no post-op nausea. The tissue graft was completely uncovered, allowing us to get a good look at it. It's quite a large bulge of tissue, slightly lighter in color than the rest of her neck & face (her face gets more sun than her thigh). Dr. Miller said that the lump will settle and spread out some on its own as it settles in. If necessary, it can later be surgically spread out some more, or reduced through liposuction, to better fit the contours of her neck and face. The great news is that you can already see the relaxing of the grafted skin on her upper face, where it was pulled down by contractures previously. Her right lip and eye are already in better positions than they were. Her thigh is also in good shape; Dr. Miller simply pulled the lips of the wide, deep incision together and stitched them in a neat line, leaving no deep scoop or imprint behind. Her thigh will quickly replace the missing tissue.
One unusual side effect- the large piece of tissue on her neck will be dead to the touch, since nerves cannot (yet) be surgically reconnected. Over time (years), Nikki will regain some sensation there as nerves from her surrounding neck areas infiltrate the newly transplanted tissue. A small price to pay for a much better look to her face.
And that's it. After 14 hours at the hospital, Bonnie & I didn't linger long. We'll be visiting her during her stay, and I'll report anything that comes up. Thanks for following Nikki's latest adventure.
Thursday, May 13, 2010
Pre-Op Report
Nikki didn't have any unusual problems Tuesday during her pre-op workup. It took five sticks to get her blood sample- not bad for her. Since being burned, Nikki doesn't have any ungrafted sites to use for blood draws. On top of that, it's very hard to find a vein under her heavily textured skin grafts. She was pretty sore by the time they finished, but the mission was successful.
The operating room is booked for eight hours, which would be a record length of surgery for her if used. Dr. Miller is anticipating 6 - 7 hours in the O/R, so we'll see. The actual procedure will be focused on her lower neck, where the constrictures always form from her neck to her chest / shoulder area. By removing these areas of tight skin, Dr. Miller anticipates that her upper neck & facial features will relax and stay relaxed. This might allow conventional skin grafting to do a better job on the upper areas, without fear of constrictures forming. But if necessary, the same radical tissue transplant procedure can be used on the upper neck & face at a later time.
Nikki is pretty well prepared for her extended time off of work & she's anxious to get this done. This will probably be my last update until surgery day, which is next Wednesday. Stay tuned-
The operating room is booked for eight hours, which would be a record length of surgery for her if used. Dr. Miller is anticipating 6 - 7 hours in the O/R, so we'll see. The actual procedure will be focused on her lower neck, where the constrictures always form from her neck to her chest / shoulder area. By removing these areas of tight skin, Dr. Miller anticipates that her upper neck & facial features will relax and stay relaxed. This might allow conventional skin grafting to do a better job on the upper areas, without fear of constrictures forming. But if necessary, the same radical tissue transplant procedure can be used on the upper neck & face at a later time.
Nikki is pretty well prepared for her extended time off of work & she's anxious to get this done. This will probably be my last update until surgery day, which is next Wednesday. Stay tuned-
Monday, May 10, 2010
Pre-Op Update 05/10/2010
Nikki goes to the doctor tomorrow for all of her pre-operative blood work and other tests. She's already been notified that we have to be at the hospital next Wednesday at 5:30am! At least she's a first case, which greatly minimizes the chances of her schedule getting screwed up. Even with Nikki staying the night before with us, that still means a 4:00am start time. We should also get a better estimate of how long her surgery will be after tomorrow.
Nikki's been preparing for her month off of work by working every shift she can get, stocking up on food at home & paying as many bills in advance as she can afford. When she has a goal to meet, she can become a real work-a-holic.
More as I have it.
Nikki's been preparing for her month off of work by working every shift she can get, stocking up on food at home & paying as many bills in advance as she can afford. When she has a goal to meet, she can become a real work-a-holic.
More as I have it.
Wednesday, April 28, 2010
Back to the O/R- 4/28/2010
Hello?.... Is anybody there? Yep, we're all alive and well. Nikki has been doing very well, continuing to tend bar at The Cheesecake Factory in Columbus, at Easton. I also returned to work in July 2009, finding a new position with a technology company after a 6 month layoff. Finally!... back to the computer field after six years!
Why am I posting after all of this time? Nikki has decided it's time to get back to surgeries, that's why. Surgery #24 has been scheduled for May 19th, with the Director of Plastic Surgery at OSU, Dr. Michael Miller, slated to perform a free flap procedure on her right neck and face. This will be a 5 - 8 hour procedure, following the same general recommendation made by the Cleveland plastic surgeon a couple of years back. A large, deep section of tissue will be removed from Nikki's left thigh and implanted on her neck and lower face. More than just a simple skin graft, the free flap is actually a microsurgical procedure. All layers of skin, along with underlying tissue, veins and arteries, will be transplanted. The veins and arteries will be surgically connected to corresponding blood vessels in her neck. This will allow the blood supply to continue to the transplanted tissue, keeping it alive, soft and viable. This tissue will be unable to contract the way that skin grafts do, preventing contractures from forming. Liposuction will be used as needed to better fit the tissue to the face. The doctor belives that her thigh will be able to replace the missing tissue with little to no scarring.
This will mean five days in the hospital, but offers the best chance to date of a smooth facial reconstruction. After this, Nikki intends to pursue further work on her right eye with Dr. Katz at OSU, as well as some more reconstructive work on her nose. She's very excited that she's finally in a position to continue with her reconstruction. We all have very high hopes that this procedure will be the one that works. I'll have more details for you as they develop.
Stay tuned... we're on the run again!
Why am I posting after all of this time? Nikki has decided it's time to get back to surgeries, that's why. Surgery #24 has been scheduled for May 19th, with the Director of Plastic Surgery at OSU, Dr. Michael Miller, slated to perform a free flap procedure on her right neck and face. This will be a 5 - 8 hour procedure, following the same general recommendation made by the Cleveland plastic surgeon a couple of years back. A large, deep section of tissue will be removed from Nikki's left thigh and implanted on her neck and lower face. More than just a simple skin graft, the free flap is actually a microsurgical procedure. All layers of skin, along with underlying tissue, veins and arteries, will be transplanted. The veins and arteries will be surgically connected to corresponding blood vessels in her neck. This will allow the blood supply to continue to the transplanted tissue, keeping it alive, soft and viable. This tissue will be unable to contract the way that skin grafts do, preventing contractures from forming. Liposuction will be used as needed to better fit the tissue to the face. The doctor belives that her thigh will be able to replace the missing tissue with little to no scarring.
This will mean five days in the hospital, but offers the best chance to date of a smooth facial reconstruction. After this, Nikki intends to pursue further work on her right eye with Dr. Katz at OSU, as well as some more reconstructive work on her nose. She's very excited that she's finally in a position to continue with her reconstruction. We all have very high hopes that this procedure will be the one that works. I'll have more details for you as they develop.
Stay tuned... we're on the run again!
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