Thursday, May 13, 2004
Skin graft site update
Those of you who've been reading will perhaps have gathered that the skin graft on Paul's left forearm, covering the donor site for the free flap, has been the slowest healing of his wounds. It has required more complicated care than Paul's head and neck incisions. Our concern about it has been the reason for the only unscheduled visit that we have made to UWMC. And it has been - despite David Wood's assertion that it was a "beautiful graft" - the most disturbing of Paul's wounds to for both of us to look at. First there was its odd purple color, then the visible tendon problem, and then the blotchy pink hypergranulation tissue that had to be burned off with silver nitrate, leaving an ugly black scab, which gave way to a more normal looking scab, which has slowly receded.
While the whole thing was covered with bandages and a splint, Paul didn't have to think about it much. After Dr. Futran suggested the he leave it unbandaged regularly, it became more difficult to ignore. Perhaps to give himself a little distance, Paul gave it nicknames. First was "the fly-swatter," because it's sort of a rounded rectangle, and the incision that runs from one end of it up to the inside of Paul's elbow looks like a handle. Then it became "the paramecium," the scab its macronucleus, and the marks along its edges from the stitches, cilia.
Finally, it appears that the healing in just about complete. Today the last small scab over the worrisome tendon came off - another small milestone in Paul's recovery. (Small milestone? Not a very elegant or satisfying description. It seems like there should be another term - a furlongstone, or its equivalent - for the marking of this small unit of progress.) The skin is bumpy and pink, and, because there is no subcutaneous fat, you can see the movement of tendons under the skin when Paul flexes his hand. We have been told that, by the one year anniversary of the surgery, the graft should be almost the same color as the surrounding skin. Looking at it today, I can begin to believe that.