Wound evolution 1 The muscle graft
This was the early phase of the grafts. Dr. Thomas Bitterly (above) performed a muscle flap graft in mid-October. On Halloween day, he inspected the work. The procedure involved slicing into a portion of the gastroc muscle from the calf, and stretching the free end from its place behind the lower leg, over the top of the leg to fill in the missing flesh below my knee. It was stapled in place to begin bonding with its new site. The upper left photo was taken November 5. Large portions of dying muscle (left) were removed on November 12.
Above, the graft on November 10 in State College and thea cleaner version two days later in Danville. I was re-admitted to Geisinger on Nov 14, where three surgeries in five days completely cleaned out the muscle graft.
Wound evolution 2: The leg progression
NOV 1 NOV 23
DEC 7 DEC 17
JAN 15 FEB 3
The leg also underwent a number of iterations, with different external fixator hardware, and different degrees of healing on the other scars and incisions. Bones within have also been knitting, but probably at a slower rate than the skin healing, since skin wounds draw healing resources away from those needed for bone healing.
Wound evolution 3: The graft site, to cover exposed bone (yellow in the Southeast corner of the wound)
NOV 1 NOV 23
DEC 7 DEC 17
JAN 15 FEB 3
The mesh (flyswatter pattern) in the earlier grafts is the actual skin graft, which they run through a machine to increase its porosity and surface area. The more recent mesh pattern is the impression that guaze makes in moist skin while under the wound vac’s vacuum. The bone is covered over; the yellow is now moist ski--the last of the wound to close. The miracle of healing is pretty amazing to watch, even if the process is glacial.
Wound Evolution 4 The inside story—not having a bone to pick
Oct 10 (note staples closing the wound over the knee) Nov 1 (cleanup on MUSCLE graft; see the bone crater?)
Dec 12 (note staples around the SKIN graft) Jan 22 (the missing section of tibia is more apparent)
The evidence had been subrhino vulgaris obvia --right there under our laymen’s noses, but we didn’t piece it together. There was a missing segment of bone beneath the knee that never made it to the hospital. It’s presumably still somewhere around Red Rose Lane, or else it was a midnight snack for some raccoon. On my January 15th appointment, I didn’t see the orthpedics team, but the plastics team had been delighted that skin had finally grown entirely over the exposed bone. I thought this was the final stage—that once the wound closed over, I could return home to frolic in the pet dander. Then the only thing that remained would be setting a date for when the external fixator could come off, so that I could begin physical therapy to bear weight on that leg, and start learning to walk again. Wrong-o, mooseface.
On January 22, Orthopedics took the above X-ray, pointed out the obviously missing bone, and outlined the details for the next surgery. They will need to perform a bone graft, taking a piece of bone from my pelvis (iliac crest) and grafting it to the tibia. They’ll probably also use some donor cadaver bone, as was used in my dental implant, to form a mortar to help cement in the wedge. We thought “Skele-gro” would be a good trade name.
We ended up our last visit of 2007 by completing all the pre-op screening for a procedure that will take place next Monday, February 11, 2008.
Wound Evolution 5: He’s a head case. Mug Shots, anyone?
Here’s another longitudinal study, documenting the prowess of medical science and the miracle of healing. From left to right the photos are (Top row) September 30, 2007, Peoria, IL; June 17, riding through Texas toward New Mexico; October 8, CT scan. The yellow highlighted fragment is actually the displaced cheekbone and broken bone in my eye socket)
Second Row: October 14, considerable swelling to the right side of my face; October 22, the rivets under and along-side my eye socket. February 8, 2008, the current look. The droopy eye is the normal one; they performed a “lift” on my right eye, and removed exactly one wrinkle. A friend (Arab scholar Art Goldschmidt) said I now look like Saddam when they captured him. Welcome to my spider hole.
Wound Evolution 5: Head case mug shots (continued) “Turn to the left”
Clockwise: June 19, jamming in the ACE hospitality suite in Albuquerque; June 24, Riding through Council Bluffs, Iowa, about 20 miles east of Omaha, Nebraska; October 8 CT scan; October 22, another “riveting” view of repairs; October 22, further evidence of empty-headedness; February 8, 2008, my imitation of Abe Lincoln on the penny, and a close-up of the orbital explosion fracture.
Wound evolution 6: Equipment, wardrobe and weight downgrades
Before: June 14, 2007, Hort Farms, State College, PA, prior to Iron Butt Ride to New Mexico
After: February 5, 2008, outside my room, Hearthside Nursing Home, State College, PA.