My 40th Surgery

Last week on Tuesday I had my 40th surgery.  They performed a release and full thickness grafting procedure on my neck.  For those of you who don't know skin grafting is the transportation of skin from one area to another.  There are two types of skin grafting: spit thickness and full thickness.  A split thickness graft, which covers most of all of my body, includes the epidermis and part of the dermis of the skin and is much like peeling an apple or potato.  A split thickness can also be put through a skin mesher where it can expand up to nine times its size.  A split thickness graft is more commonly used as it can cover larger areas and its chances of being rejected by the body is low.  You can also take from the same site multiple times after it has healed.  A full thickness graft is where they cut out the full thickness of the skin, both the dermis and epidermis, at the donor site.  The donor site is then suture closed instead of just left to heal.  Both of these are called "harvesting the skin."

I always get nervous before a surgery because I don't like being put to sleep but, I was more nervous than usual for this surgery because it was with my new burn doctor.  Nothing against him, he's perfectly capable.  It's not like he's fresh out of medical school.  It's just my first surgery with a new burn doctor and he doesn't know my complicated body that is webbed with contractions and scar tissue and how it will respond.  I usually have an early morning surgery but this time my surgery wasn't until 2:15 in the afternoon so I had nearly all day to get more and more anxious and I didn't have much to do to in the hotel to keep my mind off of it.  So, I just kept thinking about everything that had gone wrong in the past and everything that could go wrong again.

FINALLY, 12:00 rolled around and we were off to the hospital to check in by 12:15.  Everything went as normal except the time of surgery changed to 3:00 and we were not told.  So, that was a little annoying but, the time slowly ticked away with med check questions, getting an IV in, and soon Dr. Kim was in to see me.  He had me look up and side to side to see where the contractions were on my neck and the way it pulled on my face.  He also had me pull up my gown on my legs to see where the best place to take the full thickness donor site from would be.  He marked me all up with a marker on my neck and on my upper right leg in my groin area where he had decided to take the donor skin.  Then he was gone to go do an operation before mine.  Dr. Scott, my anesthesiologist, whom I have had before, walked in around a quarter to three.  I remembered him and he remembered me.  It had been awhile since I had pain medicine and I was in pain so he gave me some IV pain medicine and said they were just about ready to take me.  Three o'clock tolled and the head nurse for the surgery and the anesthesiologist came back in, put up the rails on my bed, Dr. Scott put some "feel good" medicine in my IV to calm me down and help me relax and I said good bye to my mom as they wheeled me out of my room and headed to the OR.

My surgery was about 2 hours, just as Dr. Kim said.  But he did it a little differently.  Usually they clean out the contractions and scar tissue at the site and remove the damaged skin before replacing it with the donor skin.  What Dr. Kim did was simply make a cut in the skin across the contractions, let it split open, and then ADDED skin to where it split open.  At first I thought that was really the best way to do it.  To ADD skin rather than always trying to cut it out and REPLACE the whole thing only for it to contract back down again.  But I'm worried about him not cleaning out the contractions.  I can't see how it looks because there's a bolster stitched on top of the graft.  I can feel it and it feels better, but I think I can still feel the contractions at the top of the bolster with my finger, just barely cause of the bolster being in the way and they still feel like they're popping out.  So, I'm not totally sure of how it was done.  I'll know more when I get to see it at my post op appointment when the bolster is removed.

(Bolster stitched on top of graft on the neck)

My donor site looks good, though.  It's terribly painful, though, because it's right in the crease of my groin where my thigh meets my hip and it's about 7.5 inches long.  So, I can't really stand up so straight or it pulls really tight at the donor site.  And dressing changes hurt like the dickens because it's such a sensitive area.  Getting the stitches out on that one is not going to be fun.  I am not looking forward to that post op appointment.

 (Full thickness donor site, 7.5 inches long and sutured closed)

And speaking of my post op appointment, it is this Tuesday, Nov 19th so I will know more about my graft on my neck, how it looks, feels and if it took, get stitches out, and also I hope to discuss what we will be working on next in my reconstruction.  I'm going to try talking to him about my lower lip.  It's time to get something done about that and I think Dr. Kim will get it done.  At least I hope so.