Sunday, January 15, 2012

Lima Day 5 - Anderson Gets Thumbs

Nurse Lourdis keeps Anderson occupied
After a bit of drama and lots of discussion, the decision was made this morning to proceed with the surgery to separate Anderson's thumbs from his webbed hands.  The hope is that once separated and with some physical therapy, he will be able to pick up his own fork, and pen among other things.  Right now his mother does most everything for him.  Surgery began at 9:00AM, with two surgeons, both with some background in hand surgery.  Dr. David was the lead surgeon and Dr. Tom was there with the assist.  They began by marking with a pen the area of the hand in which they would make the incisions.
The area to be cut is marked with pen
And then slowly but surely and carefully, began separating the thumbs, going through all the layers of skin, fat, muscle etc. It was fascinating to watch. Once the left hand had been successfully separated, the decision was made to go ahead and operated on the right hand also.
The left Thumb is separated
While Dr. David moved to the right hand, Dr. Tom began the skin graft, once again making pen markings very low on the stomach. Then carefully cutting around and separating the skin from the body.
Skin from the stomach will be used on the thumb
Once separated the Dr. Tom carefully scraped off the little bit of fat that was still connected to the tissue then the it was placed in a a small bowl of saline water to keep until the second thumb was successfully separated and the area where the skin was taken from was closed up.
The area is sewn up
Human Skin.  Awesome!
A blood pressure cuff was used as a tourniquet, to slow the blood flow to the hands, this way the surgeon is not trying to cut through a pool of blood. One fear was that the fused fingers may not have enough blood flow and they would die, but it looks as if Anderson has good blood flow to the fingers.
The skin from the stomach is sutured to the hand
The finished look
After he was all sewn up, the hands and much of his arms were wrapped up in sterile gauze and bandages. Upon waking up from the anesthesia, Anderson was not a happy boy. Something that I learned earlier in the day was that Anderson cannot talk and he can only hear you if you yell at him very loud, so he expressed his pain and frustration at having the bandages on his hands by yelling. He immediately tried to remove the bandage with his mouth. He is such a smart and resourceful kid. Nothing was going to make him happy. Except for moments of fascination when he would stop and look at his hands and the small amount of blood coming from the top of the bandages. He tried to pull the blood pressure cuff of of his leg and wanted to pull the needle and line to his IV bag out. He will have to keep the bandages on his hands for 10 days (or at least try to). I think that what we did to help Anderson will better his quality of life. I would love to be able to see him 3 months down the road.
Anderson and his mom getting wheeled back to his hospital bed

The other fascinating operation that I saw today was a bone graft for a left aveolar cleft on Jorge who is 8 1/2 years old.  It must be good to be the last surgery of the day.  Jorge had four surgeons working on him.  While Dr. David and Dr. Margaret took a 1 inch canoe shaped piece of bone from Jorge's hip, with what looked to be a hammer and a chisel.  Drs. Janet and Tom opened up Jorge's gums to place the piece of bone in -
The bone is removed from the hip
And sewn into the gums
The bone is then taken and sewn into the gum line in hopes that it will grow and attache to the bone that is already there. All in all it was a fascinating day and the end of a fascinating week. As tired as we were we went out Saturday night for a night on the town, dinner, dancing and the casino. We stayed out until 3 AM, and though I had an awesome time, I am exhausted. Sunday was a day off, after rounds at the hospital to see how the kids were doing. Then it was lunch, a visit to a museum and shopping. Tomorrow, more surgeries.

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