We were thrilled to find out that Camden was being released from the hospital on Tuesday. This was two to three days earlier than anticipated. I met with the docs to be trained on how to do the bandage changes. During this little training session, the occupational therapist (OT) was very distraught that Camden was being released early. OT play a very integral role in all of this treatment stuff. It is their job to make sure that the finger is immobilized, bandaged correctly, and that they are doing everything they can to ensure that the finger continues to get good blood supply so the graft will take. So, the OT was very upset because this was too early in her opinion, and against all protocol. She said that in her 12 years of experience, there was only one other time when a patient was released early. She very carefully explained to me how to do the bandages, and she put the fear of God into me that if I did it wrong by doing the bandage too tightly I could cause the tender blood supply to be cut off causing failure of the graft. But if I did it too loosely, it wouldn't have the compression that it needed to heal. We had a practice session and I felt somewhat confident. We took Camden home.
The next day I was feeling pretty apprehensive about doing the bandage wrong, so we just left it since it had been done by the OT and was done correctly. However, yesterday, day two of being home, I knew we had to change it. We'd been instructed to have a follow-up with our Pediatrician that day, so I decided to take all of the bandages in with me and have the Pediatrician help to make sure that we got it right.
Today we went back to Phoenix for our scheduled follow-up there. The OT removed the bandages and I could tell by her face that something was wrong. She called in three other OTs who started taking pictures. One of them quickly left and returned with two docs. The docs looked at it and were not happy with what was happening. The bottom part of the graft is black. This means there is no blood supply and the skin has died. It is imperative to have vascular supply, and it seems that it isn't getting it. The top part is lifting off. They kept throwing around the term of graft failure and having to do this again. I was fighting back tears and my mind was going a million miles an hour at that point so I'm not sure what else they were saying. But they did say that there is a chance that if they left it alone for another week and we didn't touch it at all except for bandage changes, maybe it would work. However, it doesn't look good.
The docs left and then another OT came in. She was apparently the head of OT and is a nurse practitioner. She carefully looked at it and then reassured everyone that it wasn't as bad as it seems. Her opinion is that the bottom part that is black is what is called overgraft. She explained that it appeared the surgeons had grafted some skin over some healthy skin, termed overgrafting, to make sure that it had adhered well. This means there naturally wouldn't be any blood supply there since there isn't a blood supply on the top of your skin so it wouldn't vascularize there. She said this part would likely just lift off and they would trim it away.
She said that the top part was a very thick piece of skin and while some of it was lifting, she didn't think the entire thing was lifting and that it was taking. I was given some warning that if the black extends any further up, or if the top part lifts any more, to bring him back right away. Otherwise we will just keep things how they are for a week and give it more time. I asked, a little teary-eyed, if when I came in next week and it didn't look good, would they immediately re-do this? She looked at me very matter-of-factly and said, "don't worry, this is going to be fine. You won't have to re-do this."
I really want to believe her, but when several of the OTs, as well as the docs thought it didn't look good, and she is the only one not worried about it, I have a very sick feeling in my stomach. It would be fantastic if she was right, but I am carefully optimistic.
I don't know if any of this happened due to Camden being released early. I wish I knew that, but none of the medical staff could say what caused it. Sometimes failure/rejection just happens. The finger is a tricky place to graft because there naturally isn't a lot of vascular supply there (I beg to differ on that given the arterial bleed that I witnessed!), so we have that working against us.
So, we could really use all the prayers that we can get that by some miracle Camden will begin to have better vascularization so that this graft can take, and that the top part will not lift any more. I can't imagine having him do this surgery again. How many times can I let them cut pieces of him off to put onto this wound? I feel really discouraged, but I am thankful that the one OT lady gave me some hope, so I'm holding on to that.
11 years ago
4 comments:
Oh, my. Mike and I have been keeping up on his progress and we are definitely thinking good thoughts for all of you.
Geez, what conflicting information! I agree with you, follow the best advice given and focus on that : ) How are you and Aaron doing? Is there something I can do to help????
I am so sorry that your family is going through so much! We will definitely keep Camden and your family in our prayers. We miss you and wish we could help in some way.
My youngest also burned his hand this summer. I had left my iron on the floor after I ironed my shirt, and he went over and burned the entire palm of his hand and each finger and the tip of his thumb. We went to see the pediatrician first and then because of contracture, we were sent to the burn unit at the U. This happened in April and we are still making visits to the Burn unit. I am sorry that you have been through so much, I know that it is not easy! Thankfully, my little guy has not had to have any surgeries, but they are still watching one area to decide what the next step is for it. Good Luck and I hope for the best for Camden.
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