Necrosis

Don't worry - I am NOT going to post pictures to this one! I have pictures for anyone who wants me to email them, but I don't want to be responsible for anyone passing out in their chair after being subjected to the photos without warning. Still, this post is not for anyone with a weak stomach.

I had (what felt like to me) a major set-back this Monday morning. On June 23rd, I'd had 5 of my 11 stitches taken out, and I'd finished up the 10-day course of Augmentin on June 24th. Things seemed to be going well, and the leg seemed to be healing. I returned to work, and I tried to return my life to normal, albeit with a limp. Over the course of the weekend, though, the lacerations on the top of my leg started to look worse and worse. There were still no signs of infection, but the skin around the edges started to look kind of a yellowish white and beyond that, the edges were bright pink and seemed inflamed. By the time I washed my leg on Sunday afternoon, I was really concerned. The yellowish white area seemed to have spread, some of the skin looked brown, and parts that once had seemed to be healing looked sunken and sickly. When my Doctor neighbor stopped by to check in on me Sunday night, she told me I needed to pull up my follow-up appointment and get in to see the surgeon right away on Monday. I'm glad I did.

The plastic surgeon squeezed me in Monday morning, and I learned that the whole area around the lacerations had become necrotic. Apparently, this is a fairly normal type of complication that can occur when there is so much underlying deep tissue trauma. Wounds heal from the inside out, and there was so much healing going on in the inside that the outer layer got starved of oxygen and just died. My doctor immediately began to open up the wounds and to cut away the necrotic tissue. After I saw the first piece of flesh get removed, I closed my eyes and tried to pretend I wasn't there. There was no local anesthetic needed: I couldn't feel a thing, since it was all dead. At some point, she did start to get down to living tissue, because I started to feel stinging and burning. She packed the wounds and told me I would need a Visiting Nurse to come each day to re-pack the wounds for me and to check progress. She said it would be at least 2 weeks before I'd begin to heal, possibly longer. I wouldn't look at my leg until they had everything packed and covered in a bandage. I was starting to lose it.

The nurse got me a tissue and let me sob for a bit, and then she told me what my leg looked like. She said I was going to have to see it Tuesday anyways, so the mental image gave me a chance to try to get my head around it. She said it looked like Swiss Cheese.

I made a follow-up appointment for Wednesday, and then headed back into town. I'm pretty sure I shouldn't have been driving, as I was an emotional wreck and my leg now felt like it was on fire. I went in to the office to hand in paperwork to the Medical Department and to get some things. My boss's boss ran into me and was very sympathetic, which just set me off crying again. Nothing more mortifying than crying like a baby in front of your department's Director at the office. I was able to catch the bus home, and then I just had a complete and total melt-down.

Immediately after the mauling and in the subsequent 15 days, I never once cried or lost it. I missed the Detroit Tigers vs. Pirates baseball game I was supposed to go to, had to give up my Craft Beer School ticket, and had to give up my place whitewater rafting on a trip I'd been organizing since October 2008, but I never once felt sorry for myself. I tolerated acute physical pain, but I didn't cry. My leg looked like Hell, but I just called it the Frankenleg and figured it would heal. Monday morning was like a nasty kick in the gut, and all day Monday and even today, I've just felt overwhelmed, upset and tearful. Life likes to throw curve balls. This one was a Duesy. (how's that for a mixed metaphor?)

I'm on doctor's orders to stay at home until further notice, so I'm off work as of Monday and have initiated a short-term disability claim. I might be able to return to work before the STD kicks in, but the claim process takes time, so I figured I was better off getting it started now, and I can always cancel it later on if the healing happens faster than expected. Right now, I'm feeling down and pessimistic, and I just want to focus on healing, taking care of the Swiss Cheese Leg and avoiding any further complications. I have three holes in my leg with exposed flesh up to an inch deep, and I can't stop thinking about the possibility of a Staph infection. I suppose in that respect, it's a good thing I didn't need to be hospitalized.

I took a shower today, and following the doctor's instructions, I pulled yesterday's gauze out of the wounds and gave them a good washing with warm water and antibacterial soap. It was my first look at them. They're pretty damn gross. Basically, where there used to be two 2" long lacerations with 4 stitches each, there are now holes. Where there used to be a 1" long laceration with 1 stitch, there is now a hole. The holes are quite deep. It's amazing to me how deep human tissue goes. I always thought my Quads were in relatively decent shape, but there's a lot of skin and adipose tissue layered on top. That's a good thing, because if the dog had been able to tear into my muscle or bone instead, I would have been REALLY messed up.

The visiting nurse came right as I was getting out of the shower (perfect timing!), and my Doctor neighbor came over, too. My neighbor helped me take some new pictures of the wounds. The nurse checked my vitals and did a fresh packing. I thought maybe there would be something really complicated to it, but it's just saline and gauze. It's like Civil War wound technology, only cleaner. The nurse soaked the 2" gauze with saline, pulled it apart to its thinnest layer, and gently stuffed and tucked it into all the crevices of the wounds. She then put dry gauze on top and a large bandage on top of that. Again I felt the burning and stinging (I teased the nurse, "Are you sure that's saline and not lemon juice?"), but it subsided after about 15 minutes. I guess the wet pack keeps the wound moist and also draws the draining fluid out towards the dry gauze. Pulling out the used gauze each day helps to pull out dead tissue and to promote healing.

I've been told wounds heal from the inside out. The human body is truly a miracle. How do my individual cells know to queue up for filling in the wound? Somehow, they do. Over the next few weeks, new tissue will start to grow, and the holes will start to fill in. I'm just keeping my fingers crossed that there aren't any further complications.