Late Surgery and Autografts

Heather didn't go into surgery until 4:45pm. It was a rather miserable day of anxious anticipation and nausea. She was quite nervous about this surgery. She was specifically worried about the pain of the donor sites and having to go back on the ventilator (Last time she was on the ventilator she felt like she couldn't breathe, and it was very distressing to her. Imagine how anxiety-provoking it would be if you had to breathe through a soda straw, and you will have an idea of why she was worried about it.).

She was in surgery for almost two hours. When she got out, she was in terrible pain. It took the doctors and nurses 30-45 minutes to finally get the pain under control (This was not for lack of effort. They were trying everything they could to make her comfortable.). During that time she was rocking her head back and forth and moaning in pain. I think it was probably the worst pain she has experienced in her whole time in the hospital. It was very distressing to all involved. I hate seeing her suffer like that. She is much calmer and more comfortable now. She is in and out of sleep and seems to have the pain under control.

Dr. Morris said that the surgery went well. They took about 180 square centimeters of skin from her back in four long strips (I got the idea that they were about two inches wide and between 8 and 12 inches long, but I could be wrong.). They were able to cover all of her leg wounds, stapling and suturing the skin on. It is her back that is causing most of her pain now. The leg wounds don't hurt much because the wounds are deep enough that most of the nerve endings are gone. However, on her back the wounds are just deep enough to hit all of the nerve endings.

Dr. Morris said that the grafts do not always take, and there is a 5-15% chance that she will have to go back in for more grafts. He is still concerned about the cellulitis in both of her hips. He said that it is not getting worse, but it is not getting better as quickly as he would like. He said that still thinks that it will get better on its own (with the help of antibiotics), but that the worst case scenario is that they will have to make a deep cut on each hip and attach a wound vac to draw the infection out.

He said that they will try not to move Heather much at all for the next three days. On Sunday they will do a full dressing change and see how the grafts are doing. Next week they will begin getting her to move and trying to stand up again. He said that if her breathing continues to go well, they will likely be able to take her tracheostomy tube out and let the hole (or stoma) close. That would be exciting!

He cannot predict exactly how quickly she will heal, but his best guess, barring the need for more grafts, is that she will be here on the burn unit until about Thanksgiving. After that she will need to spend a couple of weeks in an inpatient rehabilitation unit. He said that he feels that she will be able to be home by Christmas. I hope and pray that will be the case.

I asked Dr. Morris about scarring. He said that she will definitely have significant scarring on her legs and some scarring on her back. He said that everyone scars differently. The scars on her legs will most certainly be extensive and quite visible. The ones on her back may be very faint and hard to see, or they may have a rougher texture than the surrounding skin and be quite visible. He said that scar tissue contracts significantly. So, it will pull the flesh surrounding the wounds together, which will lessen some of the indentations on her legs.

We hope that we have just gone over the last major hurdle to Heather's recovery. We hope that the grafts do well, and that she doesn't have to go back for more.