**WARNING: THIS POST INCLUDES SOME SERIOUSLY GNARLY PHOTOS OF A DEHISCING INCISION, INFECTED WOUND AND THE AFTERMATH OF DEBRIDEMENT SURGERY, INCLUDING EXPOSED BONE, SO IF YOU ARE SQUEAMISH, CONSIDER YOURSELF WARNED.** However, not every photo is gruesome. I will try to give you advance warning when something nasty is approaching.
Sometimes life gets complicated. I have already written an account of my experience at the Warrior Dash back in late November. I think "complicated" describes the experience accurately. You can read details here. But to summarize, I broke my arm while participating in a local cross-country-type race. It was a nasty break---an open, compound fracture. That means that I fractured both bones in my forearm (the radius and the ulna), and the broken ulna penetrated the skin. I had emergency surgery that evening, and went home on the following Tuesday, right before Thanksgiving. To digress a moment, during that first stint in the hospital (yes, this is foreshadowing), I learned that I am allergic to morphine. It was fine at first, but within a couple of days, it was making me itch like crazy; I was seriously about to run screaming down the hospital corridor before we figured it out.
Here's a photo that I have already posted earlier, showing where the ulna went through the skin and the corresponding V-shaped area that my orthopedic surgeon had to stitch up. This photo is relevant to what follows. It's a bit blurry, because we took the photo with the camera phone, but you get the idea. Avert your gaze if you cannot handle the sight of stitches.
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When he discharged me, my orthopedic surgeon cautioned us that he was concerned about the V area and advised us to watch it closely. If I were to have problems, he suspected that that is where they would arise. He gave me a prescription for a broad-spectrum oral antibiotic to head off any potential infection (I think it was cephalexin).
Duly warned, we gratefully headed home. I had broken bones before, but I had never had a particularly complicated break, and certainly not an open fracture or surgery. Although I took my surgeon seriously, it really didn't occur to me that I would have anything other than a straightforward recovery. So, even though the arm was painful, I was in a fairly optimistic frame of mind. Here I am on Thanksgiving Day, showing off the t-shirt that the nurses cut off me in the ER.
Dig those crazy glasses. All I can say is, it's difficult to put in contact lenses with one working hand.
My surgeon had arranged for a local home health service to send someone to the house to do wound care and to each us how to clean the pin sites. At this point, besides the external fixator with its four pins, I also had two additional pins in my radius (they are the ones with the white bowling balls thingies attached, near the top of the shot). Don't look if you are squeamish. For reference, the incision in this shot is more or less on the other side of my arm from the V area I mentioned above.
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I had my first at-home bandage change on Thanksgiving Day, by a physical therapist from the home health care service who, for insurance reasons had to evaluate me first. At that point, the PT felt like the incision sites were doing acceptably well, but she expressed some concern over the V area. But by the next bandage change on Saturday, the RN doing the wound care took one look and strongly suggested that we call my surgeon and/or go to the ER. Because it was the weekend, we spoke to my surgeon's partner, another great guy, who was on call. He talked to me and the nurse and ultimately advised me to go to the ER to get checked out and promised he to follow up as necessary. So we went to the ER. The attending doctor took one look and said, "That's nasty. I am definitely admitting you." Here's what she saw. OKAY, THE NEXT PHOTOS ARE REALLY GROSS---DEHISCING, INFECTED INCISION AND NECROTIC TISSUE.
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What you're seeing are clear, fluid-filled blisters along and around the the two incisions, dehiscence of the skin inside the V area (probably due to a compromised blood supply), and angry red inflammation characteristic of infection. Nasty is right.
The on-call surgeon advised me debridement surgery ( a surgical clean-up procedure) was on the table, but advised aggressive IV antibiotics first, with careful monitoring, to see if we couldn't manage to turn the infection around. Sounded like a reasonable way to proceed rather than jumping into more surgery, so that what we did over the weekend. The good news was that the state of the wound did not further deteriorate over the weekend, but it didn't get much better, either. So, that Monday, after my regular surgeon returned and came to see me, I had my first surgical debridement procedure. That Friday, I had a second debridement surgery. I was under general anesthesia for both procedures. That was three surgeries under general anesthetic in three weeks. Not fun, and I am glad that I was in good physical condition to begin with. I came out of the second debridement procedure with a wound vac (vacuum-assisted closure) dressing and pump attached to my arm. Later that day, the doctor I learned was to be my plastic surgeon came by, introduced himself, and explained what he was attempting to achieve with the wound-vac therapy. In short, I now had a large open wound with exposed bone after the debridement surgeries. I would need a skin graft, but first needed to rebuild a basement of tissue over the bone so that there was something to which the grafted skin could adhere. Here's what the wound looked like after the first debridement surgery [GROSS PHOTOS AHEAD]. You can understand why a graft was in my future:
And after the second:
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Still later that day, an infectious disease specialist came by and explained that my blood cultures where showing positive for three kinds of bacteria commonly found in the soil and on the skin. He told me that, with an open wound exposing freshly-fractured bone, I would need a six-week course of high doses of IV antibiotics and probably an oral antibiotic to make sure the bacteria were eradicated and wouldn't cause me further trouble. He arranged for me to get a PICC line the next day (Saturday)--a PICC line is a peripherally-inserted central catheter.
Here is a photo of me from when we finally got home late Saturday night from the second stint at the hospital. Beside me is the beautiful bouquet my coworkers sent. The tubing coming out of my bandage on the broken arm is for the wound vac dressing and pump apparatus; I am wearing the mobile wound vac pump that will become my shadow over the next four or five weeks. The thingy in the other arm is the PICC line.
This next series of photos [STILL GROSS] illustrate the wound's progress as it heals.
Dec. 10, 2010:
Dec. 14, 2010:
Christmas Eve, Dec. 24 2010:
Dec. 27, 2010:
And December 31, 2010:
And finally, here I am at home on January 7, 2011, on the morning of surgery to get my external fixator removed and the skin graft applied. We're about to head to the hospital. This will be my fourth surgery.
Boy, that's an unflattering photo. I always manage to get my Border Collie expression on for the camera. The bed-head and early hour do not help my effort to walk in beauty like the night. But it shows me ready to rumble, and I am, and I did.
In the next post, I'll unveil the results of the skin graft. Over and out from Ptarmigan Farms.
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