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.

I felt My Heart Breaking

Anderson gives me a big Oregon "O"

He has touched my heart
I had no idea I would react this way to the kids coming in for treatment.  I knew when Anderson came in on Tuesday that he was special, he is just a big goofy kid that likes to give a show, he has boundless energy and an infectious smile, he doesn't talk but you know when he is happy.  Dr, David was very sure that he could improve Anderson's quality of life by taking his fused hands and giving him thumbs.  We had to remember that we are not in the United States and sometimes getting what we need is not always possible.  It took two days to get the correct x-rays of Anderson's hands to see if the surgery was possible and then once we got them it still wasn't clear as to what we were looking at.  It was assessed that the hospital may or may no

t have all of the instruments that are needed to conduct the the right and left thumb syndactle release...a certain sort of saw, wire and all kinds of other things that I can't remember or pronounce.  The decision was made to NOT do Anderson's surgery.  My heart sank, I wanted to cry and I did.  I couldn't even bring myself to go onto the ward to say goodbye to Anderson as I left for the day, but in the end I did.  He clowned around for me like he always does and I gave him a rubber duck.  While there the doctors were conferring about the case.  All is not lost they may still attempt the surgery tomorrow.  I am praying that they can get everything that they need to perform the surgery.

 

Sebastian 24 hours after surgery
Sebastian had a cleft lip and palate surgery therefore must remain in the hospital for one more day.  He appeared to be in quite a bit of pain but I did get a very small smile from him.  I am sure he will be up and about tomorrow.

Veronica Celebrates her 74th birthday

Yesterday Veronica at 73 years old had cleft lip surgery, today she turned 74. Many of the ROTAPLAST Team went to see her and sing happy birthday to her. Ellen one of our ward coordinators gathered up a small bag of gifts to give to her, a scarf, a key chain among other things, she didn't smile, in fact she gave no expression at all. But we are told that she was very happy with the gifts and the recognition. Apparently she rarely shows emotion. After five kids all conceived from being raped, I suppose I might be farely emotionless also. Who knows once her surgery scars have healed she will find something to smile about. All of our surgeries from Wednesday went home except for Sebastian. Cleft lip surgeries stay for one day, cleft palate surgeries stay for two. Its a long night for the team. Tonight I came back to our hotel early to set up for a class to be given by two of our plastic surgeons to a group of our local medical hosts. While the rest of the team stayed behind at the hotel to finish up two more surgeries. There seemed to be quite a few babies today, but also some four 20 somethings. Tomorrow is Saturday, another full day of surgery. Tonight is the earliest I will have gone to bed. I think I need this sleep desperately.

Sebastian - Peru Day 3

I am truly using restraint in writing this blog.  I want to talk about so much, but today let's talk about Sebastian. No, first lets talk about me. I spent about 6 hours in the operating room today, watching and learning.  There was cutting of body parts, bleeding and giving of stitches, I got up close and personal.  I felt as if I was the lone student of "Dr. David".  "Joelle, come and look at this", and he would explain to me exactly what he was doing.  I had no idea what my reaction would be to the blood and cutting, but I held my own. I've also been spreading the gospel of "Duck Love".  We have a team of 26 people and they all know that I AM A UNIVERSITY OF OREGON DUCK!  I'm putting Duck stickers on everyone and everything.  I brought with me rubber ducks to give to the kids when they come out of surgery.  I wear a Duck shirt everyday of the week down to my University of Oregon surgical scrubs, who knows perhaps we will get an influx of Peruvians attending the University of Oregon, but if all I do is make people smile and say "GO DUCKS" then I am alright with that too.
 Now let me tell you about one brave 7 year old boy named Sebastian - Sebastian has a "hole" in the soft palate and from his previous cleft lip surgery he has scar tissue that has caused his nose and lip to be a bit off, so that was repaired

"Dr. Sal" (anesthesiologist) takes Sebastian to the OR

today.  Such a brave little boy with a wonderful smile.  The first order of work was to close up the hole in Sebastian's soft palate (the very back of the mouth on top), "Dr. David" conducted what is called a "Z-plasty.  Z-plasty is a plastic surgery technique that is used to improve the functional and cosmetic appearance of scars.
I was truly fascinated by it all, from the anesthesia, to the cutting and the suturing.  Once Dr. David had completed the cleft palate procedure, he inquired with the parents,the head nurse and the chief of surgery as to whether he should continue on with the repair of the lip and nose correction, the parents wanted that very much and all concluded that he should go ahead with the surgery.  After about a 10 minute break for the surgical team it was back to work on the nose and lips.  He made several cuts in and around the nose and lips to create "flaps". He then took those flaps and over lapped them to straighten out and correct the lip that was off center and the nostril that was smaller than the other one. 

The hole in the palate has been closed

Creating the flaps to create the "cupids bow" in the lips

The left nostril is now more symmetrical with the right

I followed Sebastian in to the recovery room. where he like the rest of the kids received a hand made quilt provided by quilting organizations from all over the United States. All of the Rotaplast volunteers also tend to bring toys of all kinds to give to the kids once they wake from surgery cars, Beanie Baby's, Ducks....  I checked on Sebastian before I left this evening.  He was still pretty knocked out, but resting quietly.  I guess I should mention that Doctor David is a multi-talented person.  Plastic surgeon by day...professional drummer by night.  He can be found anytime day or night carrying his drums sticks around in his bag, during down times he will take the sticks out and practice.  I haven't figured out yet which job is his true career, I'm thinking he is pretty damn good at both of them.

Dr. David (L), Head Nurse Diane (C), Chief of Surgery (R) discuss a procedure

Today had to be one of the most rewarding days of my life.  The team of people that I am working with are - to put it simply...awesome.  Great teachers, great friends, I have laughed harder than I have in a long time, cried tears of joy and sadness, eaten some awesome meals and seen some pretty cool sights and this is only our third day.  Tomorrow, I get to see "Mr. Anderson" and hopefully we will give him some hands that he can really use.