I’ve had a lot different surgeries to try and fix my leg problem, among other body parts. I’m going to attempt to go down the list at what I’ve had done to fix my leg but I’m probably going to miss something. To quote the Grateful Dead, what a long strange trip it’s been.
When I got to the hospital pretty much the first thing after x-rays they did was insert a chest tube. That is PAINFUL. I hope you never have to have one inserted into your chest. While brief, it’s probably the most pain I’ve ever felt.
I also had a plate put in my left arm to repair my humerus fracture. They thought the bone had punctured the skin on the back of my arm, but it turns out if was a severe abrasion and cut. They also stitched that up. I now have a really ugly thick scar on the back of my arm that is going to require plastic surgery to revise. I can live with a lot of scars, but that one is so ugly I haven’t made my peace with it yet, and I probably won’t.
That however, is a surgery for another time, I have much more pressing issues going on at the moment.
While I had rib and transverse process fractures also, those didn’t require much intervention.
The biggie is and was my tibia fractures. Like I’ve said before my tibia was broken in two places, one of which came through the skin of my leg and was ground into the dirt and the gravel. The big thing they were worried about was removing all the debris from my leg before putting in internal fixation and closing it. We knew from the start that the risk of infection in my leg was a very serious concern. My accident happened on a Thursday evening and everyday until the next Wednesday or Thursday they took me into surgery everyday to open my leg and do I&D (irrigation and debridement). This week is very fuzzy for me. I don’t really remember much. They were really amazing at managing my pain, so I was very doped up. At one point they almost had to “snow” me, as in incubate me and put me into a coma because my blood pressure and heart rate were both dangerously high due to the amount of pain I was in. It’s weird to think of your blood pressure being dangerously high, and your heart racing when you are lying down and still. Thankfully that didn’t happen because then you have additional complications to deal with. So either that Wednesday or that Thursday they put hardware in my tibia to repair the upper fracture close to my knee and the lower one closer to my ankle, that consisted of a rod and pins. I didn’t have enough skin, and the swelling in my leg was so great that they couldn’t use my own skin to close where the bone came thru my leg. Enter the graft. I think the correct term is a free flap. They took skin from my upper thigh of my left leg 
, and part of my gracillas muscle from my upper inner thigh on my right leg. They took the muscle because you can’t put skin directly over bone, it has to have a cushion. They then grafted the skin onto my leg to close the wound. It’s really amazing what they did, I can’t imagine the skill it takes. If you read my previous posts you’ve seen what the graft looked/looks like. It took months to heal. I couldn’t put my leg in a dependent position until 9/10/11, so about a month I had to have my leg stuck straight out, I couldn’t let it hang down for even a second. So after all that I was in the hospital for a long time. I could barely sit up on my own when I left the hospital. It was excruciatingly painful in my back to sit up for a long time. By the time I got out of the rehab hospital I was at least able to transfer myself to a bedside toilet unassisted. I was in a wheelchair full time at that point. I gradually began to use a walker, I didn’t start using crutches until about 2 months ago. My life is a lot easier now that I am using crutches. My arms have become a lot stronger. But back to the story…So everything so far was going ok, I had internal fixation in my leg, my graft was disgusting but slowly healing. Then around the middle of September I developed the boil at the very top of my graft that was a little bigger than a quarter
. I saw my plastic surgeon who put me on antibiotics for a few weeks but nothing seemed to make it better. I had to drain it everyday and this thick yellow sort of pus like fluid would drain from it, and by the next day it would fill back up again. Nasty I know, believe me I thought it was disgusting too. So after antibiotics wouldn’t clear it up my plastic surgeon thought he should explore surgically what was causing it, make sure there wasn’t a stitch left in there irritating it, and take some cultures and see what grew. I went in for day surgery, and when I woke up they told me the infection was way worse than they expected, it had make tracks all the way down to my hardware, so now the concern was my hardware was involved in it also. He had removed the boil in the surgery and some of the infected tissue 
. Initially the tissue they cultured didn’t really grow any nasty bugs so they weren’t that concerned. My leg however didn’t stop draining. I went in to see my orthopedic surgeon who was very concerned and had me check into the hospital that day. They started antibiotics and I had surgery the following morning. Going into it I didn’t know exactly what was going to happen, it just depended on what it looked like. I woke up from surgery with the internal fixation taken out and my leg in a brace. Apparently there was pus around my bone, and they were certain the hardware was involved. Internal hardware provides a great place for germs to hang out; it isn’t vascular so no antibiotics can get to it. For the next 2 days I had surgery each day, I&D’s to clean up my leg more, the fourth day I had a medicated rod put in that was just temporary, and my leg in a brace from my hip to my ankle. The medicated rod didn’t provide much support and moving my leg around during that time was very painful without it being stabilized well. Sometime during that stay they informed me that a very nasty bacteria had grown from the cultures they had taken, micobacterium houstonese. It’s similar to TB, but not the pulmonary variety. It lives in mud and dirt. It’s pretty rare, my infectious disease dr had only seen it one other time in a car wreck victim who had an open fracture ground into the dirt. Well put it this way, micobactrerium is everywhere, it’s normally not harmful to people because your bones are supposed to be inside your body, not in the dirt. It can also live in water supplies, and people who are severely immunodeficient can be affected by it. The reason why it’s so serious is because it’s so hard to get rid of. Once we knew what we were dealing with internal fixation at that point wasn’t an option. I had a PICC line put in (peripherally inserted central catheter) my arm, so I could receive IV antibiotics. I was put on IV antibiotics and oral antibiotics. For 4 months I gave myself IV antibiotics 2x per day at home. Because leaving my leg without proper stabilization was not a good thing it was decided that an external fixator would be the best choice to stabilize it until the infection cleared. I went back into the hospital for another 10 day stay. They removed the medicated rod and did I&D’s for a few days in a row and then put the external fixator on. That was done the Monday of Thanksgiving week. They also had to remove a 4.5 cm section of my tibia where the upper fracture was because it had become necrotic due to the infection that was present. Necrotic bone is not vascular therefore just harbors germs. So then I lived with that external fixator until 2/26/11 I think, when I had the new external fixator put on by my new orthopedic surgeon in Dallas. The issue now is fixing the gap in my tibia, and getting the bottom fracture to heal. He plans on fixing my gap by bone transport, here’s a short explanation of bone transport:
Bone Transport
Bone transport is a technique that allows the surgeon to regenerate bony tissue within the patient’s extremity. This regeneration is typically used to fill a gap of missing bone due to trauma or infection. The method is particularly useful in cases of:
In order to perform a bone transport, the Ilizarov fixator is applied to the extremity and the bone is broken between rings using a variety of specialized techniques
The controlled breaking of the bone is known as an “osteotomy” or “corticotomy”.
After waiting about a week, bone transport begins at a rate of ¾ to 1 millimeter per day. Slow transport of one or more bone segments is accomplished by progressively moving a segment or segments of bone from one position to another (by distracting the ring connectors). Bone forms in the distraction site by a process known as distraction osteogenesis and the transport segment moves to fill the bone defect.
So that’s where I am now. I go in for another surgery where they will break the bone to begin the transport. That is scheduled for March 21st.
Initially they told me that I would begin walking in 3 months. It’s been 7.
crippledmusings 