Monday, December 31, 2012

The entire process of healing from necrotizing fasciitis

This has been a journey we never ever expected to have taken, but it is one we have learned much from, gained much peace from, seen incredible healing from.  From the first photos to the one taken today, December 31, 2012, here is the progress:

 He woke up at 2:00 a.m. on August 1, 2012 complaining of high fever, chills, body aches.  He was actually so hot he was hallucinating.  We iced it all day long, not knowing what it was caused by.  I finally called the doctor's office about 6:30 p.m. and was directed to go to Salem Hospital ER.

 Dr. Tracy Taggert, one of the members of the TRACS team, was on-call ER surgeon that night.  By the time she came into the room with the test results, there were blisters forming and growing to softball size and collapsing when she told him if she didn't get him into ER he'd have about an hour to live.  After he was wheeled out of the ER room it had to be sanitized from top to bottom because so much fluid had gotten onto the floor and the exam table from the blisters collapsing.  You can see by the top of the shin how bad the fever was.  It literally cooked the skin.  The line going up the side of his leg was the incision that the doctor made to peel back and see how far up the infection had spread. 

After surgery he was taken to ICU where he was kept intubated and sedated for three days to make sure he wouldn't have to go in for another emergency surgery.

 He was discharged from Salem Hospital on August 13.  Our daily appointments with the Wound Care staff began the next day.  It would take almost two one-liter bottles of saline solution to just loosen the gauze packed around the wound.  For the first month, his wrappings would be soaked by the time we'd get into Wound Care to have them changed.  He lost considerable amounts of fluid through the open wound and had to be drinking fluids almost constantly to keep his body hydrated.
 Wound Care appointments would take a little over an hour because so many layers of sterile material had to be packed around the wound and At this point, Mike's pain level was about 12 on a scale from 1-10.  He'd have to double up on his Dilaudid to get through the changes.
 The ointment on his shin is called Calmoseptine.  It's like pink Desitin and protected his skin from getting irritated by the wrappings.
 This was about the first week in September.  We were already seeing the granulation beginning.  In the photo it is the pinkish-red areas.  Up close it looked like a relief map, high places and low ones.


  





 The wound was measured weekly to track healing.  The black on the shin is scabbing from the skin that blistered from the fever.  Sometime around the first week in September the nurse, Marcia, broke out some antiseptic wipes and began washing the area and debriding the leg to remove old, dead skin and allowing the new skin to emerge.


 Wound care always began with saline solution being poured over the gauze to loosen.  Once the wound was exposed and cleaned, gauze was soaked in saline solution and layered over the wound to prepare for wrapping.
 Late September Dr. Van Der Heyden was successful in procuring the Wound VAC from KCI. Black granufoam was cut to fit on the open wound.

It was then taped completely over in place.  This would provide the air tight area needed for the vacuum pump.


 A hole was cut in the tape and the suction tube attached with peel off adhesive and then taped into place.

 It was then turned on and suction would slowly pull fluid out of the wound, causing granulation to occur.  Granulation is the growth of new meat, or tissue.

 Through trial and error the nurses figured out the best way to use this but there were more than a few sleepless nights until they got it figured out.  There was so much fluid that the pump would get overwhelmed and stop working.
 The granufoam was changed every 2-3 days, rinsed with saline solution and reapplied again.  The bright red isn't blood itself.  The capillaries in the tissue were near the surface and made the leg appear to bleed when there was actually very little blood.  The white spot near the foot is the tendon that had to be completely covered.



 Ready for graft.  By now this was October 25, one day before the graft.
 The donor site for the skin.  By far the most painful part of this whole thing.  This is covered by a yellow medicine treated cover to protect the sites.  Bled like crazy and the poor guy was in agony for about 2 1/2 weeks.
 The Wound VAC was put on in surgery for the graft and stayed on seven days.  During surgery Dr. Van Der Heyden discovered the tendon on the top of the foot to have partially died and there was a pocket of infection.  This was November 2.  That night he had a CT scan and the infection had gone into the bone on his foot.  He met with Dr. Girod who ordered a PICC line inserted into his left arm and from November 11-December 23 he went in for daily IV drips of antibiotics before or after his wound change.
 When the skin was removed from his abdomen, it was put through a little machine that hand-cranked out the skin and punctured it with a diamond pattern, creating little holes in the skin.  This was done to allow fluids to escape and allow for adhesion of the donor skin (from Mike's abdomen).




 After a week or so the graft was starting to mellow out a bit and looking more natural.







 The white fuzzy looking spots are the epithelial islands, little clusters of skin that have grown out of the granulation over the tendon.
 The graft area is very bumpy and somewhat hard.  The doctor left the muscle on the bone, but there is no fat layer to cushion and make the area soft.  Dr. Taggert also removed the lymph system from that area so he will have to wear compression socks the rest of his life to press the fluid out of his feet and up through the leg for elimination.
Today, December 31, 2012.  The graft healed beautifully, the epithelial islands are growing and one has anchored itself to the edge of the opening and by Friday should be connected to the other side, creating two small sores instead of one larger one.

5 comments:

  1. Simply amazing. The first wound pictures are very hard to look at.

    May God continue to bless you!

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  2. I have gone through the exact same process on my arm around eight years ago. I can sympathize with every single difficult step of your process. It get's easier, hang in there. Be sure to exercise and stretch as best you can so that you limit losses of mobility later.

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  3. Hi there,

    I am sorry, I'm just now finding these replies! Thank you so much for your encouragement--he's doing beautifully and we are waiting for one small area over the top tendon to finish filling in. Nine months have elapsed since this began. There are days when it seems like this will never end and then there are days when you are surprised nine months have gone by! Lori

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  4. I am a nurse. So, a part of me is completely fascinated by this. However, being a human being it is absolutely heart wrenching. I am so sorry this happened and I am quite happy to see how well the leg healed. God Bless! Thank you for sharing.

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