After Surgery at Vanderbilt, November 15, 2005

I had surgery at Vanderbilt Hospital on Tuesday, November 15.  I signed  
the standard consent form indicating possible courses of action.  Their 
intention was to go into the non-healing wound site and explore for infected 
tissue or bone, and one of the options was frightening to consider.  If they 
found deep infection in the bone, they would remove all of the hardware (the 
titanium intramedullar nail and screws) and I would wake up with a hard 
cast on my leg. I would be placed on self-administered IV antibiotics for six 
weeks to get rid of the bone infection, and then would have surgery to reinstall 
the hardware.  I would be back on two crutches in a hard cast or brace for at 
least nine weeks.  This was a serious possibility when I went into surgery.  
The other possibility was that they would not find any deep infection, and 
would simply debride the damaged tissue and take bone and tissue cultures 
to double check.  In that case, I would wake up with a soft dressing on my leg.  
Dr. Kregor was assisted in surgery by Dr. Kevin Hagan, a wound care 
specialist and plastic surgeon. 

When I awoke from surgery I immediately felt very alert, and that indicated
a quick surgery.  To my great relief, there was only a soft dressing and
ace bandage on my leg, so I knew they had not found any deep infection. 
The surgery was quite minor - they just excised around the wound site, 
removing damaged tissue.  I was in such good shape after surgery that 
they discharged me from the hospital on Tuesday afternoon. 

The image above was actually taken several days later.  The wound opening 
looks huge, but is actually about the size of a nickel.  I met with Dr. Hagan
on Friday, November 18, and he put me on a specific regimen of wound care.  
He feels that the wound will heal just fine as long as I stick to this regimen.  
I clean and re-dress the wound three times every day, cleansing it with gauze 
dipped in a mixture of antibacterial soap and sterile saline solution, flood 
rinse with saline, pat dry, and then do a wet-to-dry dressing.  I moisten a 
small wad of gauze with sterile saline, loosely pack it into the wound, cover 
with a pad of dry gauze, wrap gauze over the wound site, and finally wrap 
an Ace bandage snuggly over the foot and lower leg to help fight swelling.  
The Ace bandage had been removed right before the above image was shot, 
and thus the "stocking" impression in the leg surface.  

The objective of the "wet-to-dry" dressing is that the moisture initially 
encourages any exudate from the wound to flow, and as the sterile saline 
solution is drawn off into the dry dressing and evaporates, it draws the 
exudate into the wad of gauze, which in turn dries out partially or 
completely.  When the dressing is removed, the wad of gauze 
is usually partially stuck, and when it is pulled out, it usually 
brings with it any remaining exudate or scabbing.   

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