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Z-plasty? WTH is a Z-plasty? (Yet *another* nahtacruz blog)


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So I saw the surgeon today, and it was a very productive visit. First off, I explained my long-term goals with this to him:

  1. I want this to be the last such operation needed, with the results lasting to my dying day
  2. I want to be able to resume taking a daily walk for a mile or two, along with doing some kind other exercise a few times a week (cardio, light free weights, etc)
  3. And I want to be able to go on a lot of vacations between now and said dying day, which will likely require walking around for even longer distances

Based on all that, he agreed that just leaving this wound to heal as it is isn't a viable option. It won't be durable enough. So second surgery is back on the table.

But, because of that need for durability, he proposed a second option besides full-thickness skin graft. A procedure called a Reverse Sural Artery Flap. I'm not going to into the details of it here, beyond saying that it's most definitely more complicated than the skin graft but that in exchange it carries a significantly higher chance of success. Like, a skin graft has mid-80s to low-90s confidence in this location, but this alternate procedure bumps it up to 97%+ without requiring some of the really crazy stuff the most complicated plastics procedures can need.

I will just say here, unless you are yourself a surgeon or doctor or someone else used to these kinds of things, do not look up this procedure. I did because I wanted to fully understand it, and there are a lot of images and videos that are just... not pleasant to look at. Especially during lunch hour. 🤢

One caveat of that other procedure is that it requires a very solid blood supply in the lower leg. He wants me to get an MRA (basically an MRI but with contrast dye to view the blood vessels and how good they are), and based on that we can make a final choice between the two. Just going by my pulse in the two testable spots on the foot, he's pretty confident that the MRA will come back solid. But he still wants it so he knows going in that it's good, rather than starting the procedure and then finding out mid-way that I didn't have as good a set of plumbing as we first thought.

Another caveat is that the procedure itself requires a skin graft onto the donor site, because of the way it's done. So I'll still be dealing with a graft. Oh, and the first week of recovery has to be spent in bed with the leg elevated, followed by a couple of weeks of slowly increasing the time it's descended. How I'll do that without putting pressure on any of the areas that will be painful AF for that whole time I have no idea, although the surgeon did say my leg would be wrapped up pretty ridiculously for that first week; hopefully enough padding to distribute any pressure from pillows and such. And compared to the triple arthrodesis and shin-ankle fusion surgeries I had on the right foot 10 and 7 years ago, this is not even close to "nightmare" level.

The final caveat is that the result is, well, fugly as all get-out (based on the handful of "post-recovery" pics I found, none of which are an exact match for my situation but do give a clear idea of what to expect). But I'm not going for fashion model looks here, I just want a foot that's solid. I've gotta wear knee-high compression socks every day anyway (Bombas to the rescue!!), so 99% of the time it'll be a non-issue. And if I go swimming... well, I'll just have to be ready for some stares and possible comments.

So that's it for now. I have to get that MRA scheduled, and I also have to let the site heal up a bit more. And in any event, I can't do the surgery before April 12, when I'll have had my second Covid vaccination shot and enough time to get over the likely side effects it triggers. But this is progress, and even with the extra delays and all I should be in solid shape for when summer comes around. Which is good, because I'd like to do some kind of getaway with the missus while our younger daughter is in Japan.

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So the surgery went without a hitch. Got there at 6:15, was being carted into the OR right on time at 7:30. A few minutes later, I was in blackout from whatever cocktail they put in my IV before wheel

I forgot something in that last update. Our younger daughter (aka the artist, whose work I’ve shown in earlier live blogs) got her acceptance notice for the summer Japanese Language and Cultural Immer

Hey all! Doc said the surgery went great, no problems at all. I’ve got one heck of a sore throat from being intubated for anesthesia for 2+ hours, and I’m only just now getting off my usual post-surge

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29 minutes ago, WAAAYTOOO said:

if it will give you the results that you are looking for, it will be worth it....eventually.

Best of luck !

Raye, this is exactly why I’m not shying away from it. I put off getting the big foot surgeries on the right side for a decade, having been told that they’d be nightmares and that life afterward would be problematic. Well, they certainly no cake walk, but knowing the outcome and how well I still move for my needs, I’m kicking myself for those extra 10 years of pain. Not making that mistake a second time, especially with a surgeon I feel this comfortable with and who has as much experience as he does.

Edited by JLMoran
Autocorrect doesn't recognize the name Raye?!? 😖
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3 hours ago, JLMoran said:

I will just say here, unless you are yourself a surgeon or doctor or someone else used to these kinds of things, do not look up this procedure. I did because I wanted to fully understand it, and there are a lot of images and videos that are just... not pleasant to look at. Especially during lunch hour.

Too late..... 😄

To be fair though, I'm the guy who watched my wife's c-sections intensely and was fascinated by them.  I've also been a butcher since 1985.  🤷‍♂️

On a serious note though, it really is amazing what can be done medically nowadays.

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8 hours ago, JLMoran said:

And if I go swimming... well, I'll just have to be ready for some stares and possible comments.

You can always say it's results of a shark bite from your last cruise. 

Really though, you have some realistic goals and it will be the end of all you troubles. Good luck and we're still praying for you. 🙏

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  • 3 weeks later...

So this week has been kind of busy. Started off the week getting my surgery date locked in, regardless of which procedure he'll end up doing -- April 12. So I have just over a week of putting up with this, and then the recovery fun begins.

Once I had the date locked in, I called up the leave of absence coordinator and let them know I'd be out of the office starting on that date. "How long will you be out of work this time?" Umm.... doctor said to give it a month.

I had the MRA taken on my leg yesterday. Went fine, was a bit different than a regular MRI. I was still slid into the giant tube (no longer the old coffin-style, thank goodness) and still had to stay completely still for 30 minutes or so. But before all that happened, I had an IV started in my arm. And then I had a bunch of ECG-type electrode pads (which are connected to the MRI machine) placed on my chest. During the final 10 minutes of the test, they injected a contrast dye through the IV, and the MRI used the ECG signal to sync its scans to my heart beat before the dye could break down in just a couple of minutes. The goal was to catch the contrast dye, which contains a semi-magnetic metal and interacts with the MRI's magnetic field, as it flowed through the arteries of my leg so that they could get a clear picture of the arteries.

When it was all done and I was told all the images were clear, I asked the technician how often he has to do that particular test. I was expecting him to say a couple a month, maybe just one every few months. I was way off. He said he gets one patient like me in a year.

giphy.gif

I got a CD with the results as I left, but there wasn't really a need. I called the doctor's office this morning and confirmed he had his own copy waiting for him on his desk. Unfortunately, I'm still waiting to hear back from him as far as whether it gave the "right" results that clear me for this reversed sural flap procedure, or if I'll "just" be getting a skin graft.

Since I'm in hurry-up-and-wait mode, I just used the money I haven't spent on cruises (and then some) to buy a car.

image.thumb.png.5a229b37603bbdc77bc1c6b1f7f1cb55.png

My 2011 Sonata has been a bit overdue for replacement for a while now, and this lovely lady just showed up in Carvana's inventory last night. Fully loaded, only 10,376 miles, and nicely under my budget thanks to a higher than expected trade-in value. Couldn't have been easier. Well, besides the two months of frustration searching daily for a car like this, finding a few that could have equally worked but got snatched up by someone before I even knew it was there, a few more that were well over my budget, and a whole lot of "NOPE!" inventory.

They'll be delivering it to my house on Monday, and hauling away the old car. Good thing I have tomorrow off; I need the time to clean out the Hyundai, give it a good vacuuming and take it to the car wash.

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1 hour ago, JLMoran said:

So this week has been kind of busy. Started off the week getting my surgery date locked in, regardless of which procedure he'll end up doing -- April 12. So I have just over a week of putting up with this, and then the recovery fun begins.

Once I had the date locked in, I called up the leave of absence coordinator and let them know I'd be out of the office starting on that date. "How long will you be out of work this time?" Umm.... doctor said to give it a month.

I had the MRA taken on my leg yesterday. Went fine, was a bit different than a regular MRI. I was still slid into the giant tube (no longer the old coffin-style, thank goodness) and still had to stay completely still for 30 minutes or so. But before all that happened, I had an IV started in my arm. And then I had a bunch of ECG-type electrode pads (which are connected to the MRI machine) placed on my chest. During the final 10 minutes of the test, they injected a contrast dye through the IV, and the MRI used the ECG signal to sync its scans to my heart beat before the dye could break down in just a couple of minutes. The goal was to catch the contrast dye, which contains a semi-magnetic metal and interacts with the MRI's magnetic field, as it flowed through the arteries of my leg so that they could get a clear picture of the arteries.

When it was all done and I was told all the images were clear, I asked the technician how often he has to do that particular test. I was expecting him to say a couple a month, maybe just one every few months. I was way off. He said he gets one patient like me in a year.

giphy.gif

I got a CD with the results as I left, but there wasn't really a need. I called the doctor's office this morning and confirmed he had his own copy waiting for him on his desk. Unfortunately, I'm still waiting to hear back from him as far as whether it gave the "right" results that clear me for this reversed sural flap procedure, or if I'll "just" be getting a skin graft.

Since I'm in hurry-up-and-wait mode, I just used the money I haven't spent on cruises (and then some) to buy a car.

image.thumb.png.5a229b37603bbdc77bc1c6b1f7f1cb55.png

My 2011 Sonata has been a bit overdue for replacement for a while now, and this lovely lady just showed up in Carvana's inventory last night. Fully loaded, only 10,376 miles, and nicely under my budget thanks to a higher than expected trade-in value. Couldn't have been easier. Well, besides the two months of frustration searching daily for a car like this, finding a few that could have equally worked but got snatched up by someone before I even knew it was there, a few more that were well over my budget, and a whole lot of "NOPE!" inventory.

They'll be delivering it to my house on Monday, and hauling away the old car. Good thing I have tomorrow off; I need the time to clean out the Hyundai, give it a good vacuuming and take it to the car wash.

Hey Joe,

Wish you the best with your "procedure". Hope all goes well and gets you back on your feet quickly, so to speak. As far as "clean out the Hyundai, give it a good vacuuming and take it to the car wash". Yes I would clean out my personal stuff from the interior and trunk. But I WOULD NOT spend anytime/money vacuuming nor doing the car wash. Car dealers have folks on their payroll who do all that stuff regardless of what the vehicle looks like when it's traded in. Not unless this is a requirement that Carvana has. Keep us in the loop on your surgery progress, again wishing you the best!😎

rjac

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A long-awaited day has finally arrived...

729186848_GotmysecondCovidshot!.thumb.jpeg.4a2ad61e09c16edeabfcbf2667f9a18e.jpeg

Bit longer this time around, thanks to a larger crowd. But still only 30 minutes from getting on line to getting my arm jabbed; about 25 minutes of that time was spent just slowly snaking along the line. Arm is a little sore and not really anything else so far, but I remember it takes around 8 hours before second-shot side effects really start to hit. Hoping my immune system shows a good, strong response to this second jab.

 

Oh, and @rjac -- I totally hear what you're saying about not taking any major time or spending money. But the front part of the car was really quite a mess and I'd be embarrassed handing it over to the delivery guy in that state. I just used one of our older vacuums to clean up the worst of what was on the front mats and floor, and some cleaning wipes to get the major grunge up off the dashboard and console surfaces. The rest I'll leave to their detailing team; at least now the car looks lived in but not like a dumping ground. 😅

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On 4/1/2021 at 8:15 PM, JLMoran said:

 

giphy.gif

Since I'm in hurry-up-and-wait mode, I just used the money I haven't spent on cruises (and then some) to buy a car.

image.thumb.png.5a229b37603bbdc77bc1c6b1f7f1cb55.png

Hey, I did the same thing!! Interestingly I traded in my fusion and got an explorer. Like @rjac said, I only got my junk out of the car. Mine was a 2010, pretty rusty courtesy of our salt filled winters, and had been in an accident. I knew mine was headed straight to auction and probably scrap, no need to detail it for that!!

Good luck with the further procedures!

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8 minutes ago, GregD said:

Hey, I did the same thing!! Interestingly I traded in my fusion and got an explorer.

Which is funny, because when I was first looking at hybrids years ago, the Explorer was one of the higher-rated options. But I just loved my BIL's Fusion Hybrid (his was the first model year released; 2011?) and have been itching to get one ever since. This one that was just delivered today is WAAAY more refined and spacious feeling than that original model (which IIRC had a lower roofline and might have been a bit narrower). And wow is it quiet! Took it for a test drive on delivery, road noise was almost non-existent.

 

Oh, and for those who are getting their second shot of Pfizer (and probably Moderna, based on tales I've heard) -- be ready for a rough day after. I was knocked out all day yesterday with body aches, low-grade fever, a sometimes-pounding headache, and just feeling totally beaten-down. Tylenol (all that I'm allowed now that I'm a week out from surgery) didn't do a heck of a lot, but at least it was only the one day of miserable-ness.

You know you're feeling lousy when you choose to watch the Ultimate Edition cut of "Batman vs Superman: Dawn of Justice", followed by the Zack Snyder cut of "Justice League"... and don't feel like that was seven hours of your life you'll never get back! 😂

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Finally heard back from the surgeon. Seems my results got misplaced or something, and they only found them today. Test came back good, as expected, so I'm all clear for the flap procedure. And he spent a good bit of time answering my questions that I came up with based on what I'd read about it, so I'm feeling a lot less nervous now about what to expect and overall prospects.

Surgery is on Monday, at 11:30 AM. Glad I won't be up at the crack of dawn, but I'll be up VERY late Sunday night to make sure I have a good meal before my fasting window begins.

Hmm.... if it's right at midnight, is that still second dinner or is it first breakfast? I've gotta keep the proper Hobbit meal order after all. 😁

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Just wanted to let you know that I hope all goes well tomorrow!   I’ll be thinking of you.  More importantly, please remember that beauty comes from the inside out-not the other way around.  This, whatever the outward appearance of your foot, it cannot impact the the true beauty of your essence.

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Hey all! Doc said the surgery went great, no problems at all. I’ve got one heck of a sore throat from being intubated for anesthesia for 2+ hours, and I’m only just now getting off my usual post-surgery nausea (or maybe not so much; sat up to help with doing the breathing exercise that helps clear the anesthesia and felt another wave hit me 🤢). But foot is decently comfortable with meds; and doc said he wants to see me tomorrow to change the dressing and do an initial evaluation.

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31 minutes ago, JLMoran said:

Hey all! Doc said the surgery went great, no problems at all. I’ve got one heck of a sore throat from being intubated for anesthesia for 2+ hours, and I’m only just now getting off my usual post-surgery nausea (or maybe not so much; sat up to help with doing the breathing exercise that helps clear the anesthesia and felt another wave hit me 🤢). But foot is decently comfortable with meds; and doc said he wants to see me tomorrow to change the dressing and do an initial evaluation.

Glad to hear it, Joe!  Fingers crossed that the news continues to trend positive!

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Saw the doctor today for dressing change and to confirm everything looked good. He said it looked perfect! 😁

Color of the flap is exactly what it should be, the skin graft is taking properly, and he had even been able to simply stitch the larger “paddle” section closed instead of having to graft that as well.

I have a big lump where the graft is located, and he warned me not let that area get any pressure put on it; if it does that can badly impair circulation and cause me problems. So I’m being careful when propping it up on pillows, and going to make sure to baby it for the whole week.

Next follow up in about a week. I’m certain that as long as I take good care of it, this really will fix everything and I’ll be right as rain again. ☺️

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Nothing new here, really. But I just have to comment on how amazing modern surgery and pain relief have become. For context:

  • Somewhere in the early 80s, when I was in middle school, I had to get bunion repair done. I woke from surgery screaming in pain and had to get a shot of whatever that time’s pain med of choice was right in my keister. Which knocked me right back out.
  • In 2011 and 2014, I had bone fusion surgeries. I got a nerve block that let me wake up with zero pain, but desperately needed the morphine drip for 24 hours and was on strong pain meds round the clock for about three weeks, and not fully off them for a good few months.

This surgery, I was given a set of local anesthetic injections that I was told would last about 3 days. I’m on day 5 post-op and I STILL DON’T NEED ANY PAIN MEDS, apart from one when I go to bed so I can sleep comfortably. And I’m sleeping for 7 to 9 hours at a pop. I still get occasional stings from the donor site, or a suture that had a little too much pressure on it. But they go away within seconds and I’m not even bothered by it all that much.

I fully realize that skin-level work like I just had is almost certainly a heck of a lot less painful than having an entire set of bones broken and nailed together. But to not need anything at all except to sleep, and that one dose lasting for a normal night and then some, is mind-blowing to me. I’ve always feared surgery because it has always meant a nightmare of pain afterward. The advances that have happened in the 40+ years of surgeries that I can remember are just... miraculous.

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I stumbled upon this blog just yesterday and read through it.  Having had toe surgery (cheilectomy [happily avoided an arthrodesis by the skin of my teeth!!]), I truly know the pain...although your surgeries sound much more complex to mine.  Anyway, I am happy to hear this latest surgery/recovery is going well!  Thank you for sharing.  

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