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.