Surgery Results

Heather is out of surgery and doing well. They operated on her for a couple of hours and found that they needed to remove more tissue from her legs. They removed a relatively large amount of tissue from the outside of her left thigh and some tissue from the inside of her left thigh and from the outside of her right thigh. Dr. Morris said that the tissue in these areas still had some infection and/or necrotic (dead) tissue. He explained that they try to get all of the infected and necrotic tissue out while being as conservative as possible, so as to leave her legs intact as much as they can. The problem with this approach is that they may miss some of it and have to go back for more. In addition, there is always the possibility of additional infection cropping up.

Dr. Morris said that they took a little more fascia from the outside of her left thigh, but still did not have to get into muscle. He said that it is not unusual to have to go back in to clean things up like this, but of course we would all hope for Heather to have ideal healthy skin that is ready for grafting. She currently has no grafts at all (neither of cadaver skin nor of her own skin). Dr. Morris was unsure when he would try grafting again, as it depends on how her skin heals.

They covered the affected areas of her legs with wound vac dressings. This is where they cover the wound with black foam, cover the foam with a plastic tape layer that forms an air-tight seal around the wound, cut a small hole in the plastic tape layer over the foam, and attach a machine that sucks all the air and fluid out of the foam and the wound area. They have also put her on an antibiotic to fight any infection.

Dr. Morris was reluctant to give any timeline at this point, other than that they will change her dressings and look at the wounds again on Saturday. It is just hard to know how the wounds will progress and when she will be ready for grafts. He is still optimistic.

Some people have asked me how her legs got so bad in the first place. I don’t completely understand it myself, but here’s my best explanation. Apparently, the toxins associated with sepsis and other similar diseases or conditions cause what is called “disseminated intravascular coagulation” or DIC. Wikipedia defines DIC as:

Disseminated intravascular coagulation (DIC), also known as consumptive coagulopathy, is a pathological activation of coagulation (blood clotting) mechanisms that happens in response to a variety of diseases. As its name suggests, it leads to the formation of small blood clots inside the blood vessels throughout the body.^[1] As the small clots consume all the available coagulation proteins and platelets, normal coagulation is disrupted and abnormal bleeding occurs from the skin (e.g. from sites where blood samples were taken), the digestive tract, the respiratory tract and surgical wounds. The small clots also disrupt normal blood flow to organs (such as the kidneys), which may malfunction as a result.^[2]

DIC can occur acutely but also on a slower, chronic basis, depending on the underlying problem.^[3] It is common in the critically ill, and may participate in the development of multiple organ failure, which may lead to death.^[4]

Basically, the sepsis reaction causes tiny blot clots to form in the capillaries, which kills the tissue in the affected areas. In Heather’s case, the only affected areas were her thighs. Several nurses have said that they often have people here on the burn unit who are not as fortunate and end up losing limbs from this condition.

While Heather was in surgery, the doctors changed the tube for her tracheostomy. The new tube will allow her to talk and eat when she is not connected to the ventilator. That is very exciting to me.