5 August 2022
Joyce had an appointment with Lady the RN (whose green hair is now blonde) at the plastic surgery clinic this morning. It took half an hour, near the end of which Dr. Tong took a look at where things stand. Then she came into the waiting room to bring me up to date.
There was no one there but me and Mark the Receptionist. And he was listening to the Kaiser "hold" message for the third time. "If this is an emergency..."
Dr. Tong told me she liked the color of the muscle. It could itself support a layer of Integra now. With just a little cleanup.
But the fatty tissue alongside it is still covered in yellow slough (the wrong color yellow, she said, it should be lighter). She could excavate that, she thought, to get back to the good tissue to try to close the wound but "there are risks."
That the Integra wouldn't adhere to the fatty tissue after all. And even if it did, there would be quite an indentation back there. But sooner or later she would do something to try to get the skin to grow into the wound.
And no, you can't do half the wound and worry about the other half later. I had thought that was what she was talking about at first.
I wondered if digging under the yellow slough wouldn't reveal more of the dead tissue we saw after the last surgery.
So I pulled up the gallery of wound images* on my phone to show her the older one that documents some necrosis in the area of the yellow slough. That didn't worry her.
She used the photo to show me what she had in mind, which was about what I had imagined.
And while I was at it, I asked her what she thought about Dermistat, which sister Judy's old friend Lynn Fegadel represents on the East Coast. Dermistat takes a small skin sample from the patient (usually behind an ear) and grows it into a thin skin graft.
I discussed it with Lynn in July, explaining we weren't at the grafting stage yet but promised to ask Dr. Tong about it.
Dr. Tong did know about it, particularly its use for burn patients. But, she said, it's a little fragile for this situation. And it takes quite some time to grow, she added.
But, she summed up, she was encouraged. The wound is stable, not infected, just not changed much. We're doing a good job. She thinks another series of surgeries after the end of the year might help bring the fatty tissue up to the level of the muscle so she can try that Integra layer and, if that binds, the skin graft.
So we'll carry on with the daily dressing changes with the Santyl and return to the clinic sometime in September.