Monday, February 16, 2009
Sunday, February 1, 2009
Kai quickly got tired of this, so we tackled it every other day. We talked with doctors who suggested working the edges with a Q-tip soaked in hydrogen peroxide. Really, really tedious. Here's what's left of the dressing as of Sunday, Feb 8:
It looks pretty good and you can even see hair growing back the skin graft region.
Friday, January 30, 2009
At Kai's 3-week post-op visit (around Feb 12), a Portland doctor will remove the sponge, the first layer of gel foam, and the silastic disk. The last layer of gel foam will remain for another two weeks.
The doctor also *tried* to remove the dressing on the skin graft. He snipped the stitches that were originally holding it in place and removed the tape. Unfortunately, the dressing had slipped and the tape was stuck to part of the wound. Needless to say, removing the tape caused a lot of tears. Also, the dressing wouldn't come up even after the tape and stitches were removed--it had adhered to the raw skin. So... we get to soak it off. Ugh.
Monday, January 26, 2009
Yesterday we visited our friend Jonathan in Berkeley. The highlight for the kids was riding the steam engine trains in the Berkeley hills. The train rides and the drive to and from Berkeley helped keep the kids from getting too rambunctious. Here we are about to take a ride on a 7-1/2 inch gauge railway. It was a hoot.
Today, we went to San Francisco and wandered around Golden Gate Park. On the way home Kai complained that the skin-graft area itched a lot. He kept trying to rub the bandage covering it. We have a follow-up doctor visit tomorrow at noon and, hopefully, they can help us deal with the itchy skin graft. Then, we finally get to go home! It's been a really long week...
And… here’s the new ear opening! The picture at left shows the arc of the incision line behind the right ear. It also shows the ear canal with a circular sponge filling it. The sponge helps ensure that the new hole and canal remain open; the sponge is also soaked with an antimicrobial or antiseptic solution. The hole is pretty large but, apparently, it’s purposefully that way because the opening will shrink as it heals.
I’ve spared you the gore of the skin graft: to the left of the incision is a 3 x 3 inch square that is covered with a clear plastic dressing that’s stitched in place. To me, it looks like a bloody mess but the doctor assured us it looks worse than it is. The doctor who prepped us likened the skin graft to “a really bad scrape”.
Here’s Kai at brunch afterwards with the surgery site bandaged:
Fortunately, there's a convenient gap between the skin graft area and the behind-the-ear incision
Thursday, January 22, 2009
Right Reconstruction of External Auditory Canal for Congenital Atresia, Tympanoplasty, Split-thickness Skin Graft, Ossicular Reconstruction for Congenital Anomaly, Continuous Intraoperative 7th Nerve Monitoring, Baseline Electrophysiologic Study, MicrodissectionMy understanding of the above: Dr Roberson created the ear canal with skin from the split-thickness skin graft, which they took from Kai's scalp on the right side of his head. For the tympanoplasty (creating the eardrum), Dr Roberson took a graft from a muscle in the jaw. As far as "ossicular reconstruction" (rebuilding the middle ear bones), it sounded like Dr Roberson didn't feel it was necessary. He said the stapes wasn't as flexible as he'd like but it was good enough. Apparently, the "7th nerve" is the facial nerve. They monitored proximity to it to ensure they didn't get too close and accidentally cause damage. I'm assuming "baseline electrophysiologic study" just means they tracked his vital signs and, frankly, I have no idea what they mean by "microdissection". I'll have to ask tomorrow.
Most importantly, the surgery went well and the prognosis is excellent. The only bit of trouble occurred when they removed the breathing tube--apparently, he woke up flailing and managed to remove the bandage around his head. To quiet him, the anesthesiologist gave him a healthy dose of Fentanyl, which Keddrick says is similar to morphine but has a shorter half-life. (Keddrick, the experienced surgical patient, says he personally prefers Demerol above all others.)
Here's Kai in the recovery room sleeping peacefully with his new purple turban:
He woke up gradually and was able to go home about two hours later.
Altogether, we were there for 6 hours. Seemed short to me but I'm still amazed that it's an outpatient procedure.
Here Kai is again sleeping with his favorite blanket ("flower") on the way back to the hotel:
Tuesday, January 13, 2009
When we brought Kai home in June, our first step was to have his hearing tested. We learned Kai's hearing threshold is about 70dB, so, unaided, he can hear loud machinery (like the vacuum cleaner) but can't hear normal conversation. As a result, Kai had almost no language when most children have enough speech to express basic needs and identify people and objects in their environment.
After getting the chance to adopt Kai, we learned there were a number of treatment options, including ear canal reconstruction (canalplasty). There are a limited number of doctors out there who will remove the skull bone obstructing the ear and create an ear drum and ear canal using a skin graft. We decided this type of procedure was for us, and fortunately, Kai is a good candidate for this type of repair.
Over the next few years, we'll use this blog to chronicle Kai's surgeries, recoveries, and the resulting changes in his hearing and speech. We'll also share what we learn along the way.