Saturday, July 17, 2010

Wide Excision

On July 12, 2010, I had my second surgery. It was on my right armpit this time. You can see that there was one big open wound and another forming right in front of it. You can also see the purple scarring again along with other bumps that were starting to form. There was also a red ring around my armpit which was from the infection that was going on...  
From Hidradenitis Suppurativa

I went in to get prepped for surgery and the surgeon came in to mark what side was supposed to be done.  She marked around where she was going to take the skin from, which was a much bigger section than I thought she was going to take. I went in about ten minutes later and they put me under. I was out of surgery in an hour and a half and was in the recovery room for another hour. After that, I was taken up to my room. I had a wound vac on and could not figure out why my leg hurt so bad, so I moved my gown over and realized that the skin graft that she had taken was massive compared to what I thought it would be. I did not take any pictures while in the hospital but this is what the donor site looks like six days later
From Hidradenitis Suppurativa
Now the donor site actually wraps around to the side of my thigh a little bit but it was hard to get all of it in the picture. It looks much better in that picture than it did while I was in the hospital, but it is all I have to show the size of it.

Day One in the hospital -  I slept most of the time outside of them coming in every hour to give me meds, check my vitals, and check my wound vac. I was told to move my arm as little as possible and to keep it slightly out to the side to help the graft take.  My arm did not hurt at all, but the donor site hurt like hell. It felt like someone was taking a blow torch to my leg. No matter what pain meds they gave it did not seem to help the pain of the graft site. My armpit had a black wound vac sponge on the wound with a very tight clear dressing over that to keep things in place. On top of that was a bunch of gauze and such which the surgeon said was just to keep me from freaking out when I woke up, but she left it on anyway. I was told that my arm dressing would stay on until Thursday or Friday when I got discharged. My leg also had a clear tight bandage thing on it and I was told that it would stay on as long as possible.

Day Two in the hospital - Again I slept most of the time and they spent their time checking vitals, giving meds, and checking my wound vac. I saw the surgeon in the morning where she just asked me how I was feeling and made sure my dressings were still in place. She also checked the wound vac and again told me to keep my arm as still as possible and not to move it when I got up for the bathroom and other things. I was still in a ton of pain from the graft site, but the pain meds (Demerol and Toradol through an IV) kind of made me loopy so I didn't really care to much. Looking at my donor site you could see that the bandage was filling with a lot of blood. The theory is that you do not want to change the dressing because once the site starts to heal it will absorb all of the fluids that are left in the bandage so it heals better. Anyways it was really gross cause I could feel it slosh around every time I moved my leg.

Day Three in the hospital -  At two in the morning, I woke up because my leg was wet. I moved around a bit and realized that my bandage had indeed sprung a very big leak. I pushed my call button for the nurse. I stood up and tried to hold a cloth were the leak was but since I am not supposed to move my arm this did not go over so well.  I stood there for about ten minutes and the nurse still had not come in, so I got more blood on the floor than was necessary. She finally came in fifteen minutes after I had pushed the call button and helped me get sort of cleaned up. Then she took the entire dressing off of my leg which hurt more than I can explain.... it's like putting tape on a really bad sunburn and then ripping it off. She then decided she was going to wet a gauze pad and pat it on my donor site which I thought was going to kill me. It hurt so bad I was almost in tears and she kept asking "are you okay, hun?" No I wasn't okay I was almost crying... after that was over she got me a new dressing for it. It felt so nice to not have air hitting the graft site and have her not touching it.  I finally got to go back to sleep around 3:00am and still got woke up every hour or so for all of my checks. They took my IV out in the morning which was nice, but they left the lock in so they could still give meds through the IV if they needed to. I got up and walked around the halls of the hospital with my husband and visited with friends & family. I complained of pain in my leg a lot, but it didn't matter because nothing they did seemed to make the pain better.

Day Four in the hospital - The only thing important that happened today was my surgeon said that the nurse could peel back a little bit of my graft cover and put some lidocaine jelly in it to if that would help. Well it did help, but only the area that it got to which was about the size of a quarter.

Day Five in the hospital- The nurse came in at 6:30am to give me pain meds so I could tolerate the surgeon taking off my dressings at 7:30am.  Well the first thing she did was take off the wound vac which actually did not hurt so that was cool. Then came time for her to take the big bulky gauze off, which didn't hurt either. So I thought it was going very well. Then is was time to take off the plastic wrap looking stuff..... talk about pain! It was very stuck, but she just kept pulling. Then she got to the area around the graft and I think the stuff was stuck to some of the staples that I have. Then she had to take off the black sponge which did not hurt very much at all, thank god cause I couldn't handle it.  The doctor talked to me about the pain in my leg and told me she would give a prescription for Neurontin, she was pretty sure that would take care of the pain. She talked to me about how I could not get my donor site & armpit wet for four weeks, explained again why not to move my arm, and told me I would be having nursing staff come into my home once a day for four weeks to change my dressing(s).

Day Five at home - I took the Neurontin along with my Norco and waited about an hour and a half and my pain went from about an eight to a four on the pain scale - which was amazing.  My graft site had a few small leaks that had to be patched up, but overall things went fairly smooth at home.

Day Six which is today - I am trying to keep on schedule with all my meds otherwise it starts to hurt more, I'm not always right on time. We must have done a fairly decent job of patching all of the small leaks because I had none during the night. The home nurse came today and barely had the stuff to do my dressing change, although in her defense no one told her what special things I needed nor did the hospital give me supplies. I was so afraid it was going to hurt, but it didn't hurt too much.  It only really hurt when part of it got stuck to my staples... go figure. The Neurontin doesn't seem to be helping as much today as it did before but I get to take another pill at 9:00 so we will see. This is what my skin graft looks like as of today
From Hidradenitis Suppurativa

Now it does wrap around a little farther than what the picture shows.  Hopefully I can get a better picture with tomorrow's dressing change. The nurse said it's looking really good and if I keep doing a good job at not moving my arm the whole graft should take.

15 comments:

  1. Does your nurse use xeroform directly on top of the skin graft? It was wonderful stuff for me. It prevents infection and the best thing is, it is petroleum based and will not stick to the wound at all. It was my life saver. I would lay a sheet of that on top of the wound and then put a lot of gauze to catch all the fluids. Boy, do those areas drain nonstop. I then used an orthopedic ACE bandage so the fluids didn't leak and it kept all the bandages in place. Just a suggestion. :)

    elizabeth

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  2. How come they took out the skin? I'm kind of worried now since my second surgery is on the 29th and I'm having it on both armpits and around the groin area.

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  3. @Hungryturtle
    Hey they took the skin from under my armpit because it was so wide spread. So my surgeon took an aggressive approach to try and eliminate the problem. If you are having surgery you should know what kind you are having before they do it, so I would ask. If they didn't say anything about skin grafting then I would say that's not what they are doing, but then I don't know because I'm not your surgeon. Please make sure you ask before you go in. It's really important for you to know. Good Luck!

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  4. @Anonymous
    Yep that's what they use! lol. My surgeon actually has me on home care. So I have a nurse coming in once a day for four weeks to change my dressing. But yea they put gauze over it and then cover it with an ABD(a thick gauze like pad) and then wrap it so I don't have to have a lot of tape on me :) I used something like ace bandages on my last surgery to keep the dressing on them and it worked well. It was just like an ace bandage but made out of a material that would stick to itself but not skin. Hope you have a good night.

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  5. The stretchy bandage in called Coban. Coban is used on humans and does not contain latex. If you aren't allergic to latex, you can purchase a product called VetWrap from the 3M Company. It's 4 inches wide, comes in a lot of different colors, and is about $2-3 a roll. You can find it at tack shops or farm supply companies. I've used it for years on my dogs and horses, and it does not slip or stick to fabric, or your skin or your hair.

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  6. Did the surgery help with the ptoblem or are you still having boils under your arm? Im considering the surgery but not 100% sure if its a good idea.

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  7. I have had no problems with my arms since the surgery

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  8. I developed an infected abscess in my armpit.I had Hidradenitis surgery twice. Each surgery was 20 years apart and it was a slit from one side of my armpit horizontal to the other side of my arm pit. The first surgery removed about 6 inches of sweat glands from my armpit. The same slit was used for the second surgery removed infected sweat glands about the size of a small banana. Both procedures was done on an outpatient basis. I was released with a prescription of Hydrocodone-Acetaminophn 5-500 tablets (generic for Vicodin). I was not able to use deodorant AT ALL!!! DO NOT sleep on your arm or overstretch it. You may have to nurse it until you get some relief. DO NOT shave your underarm!!!I found that removing hair with Nair or Neet hair removal cream will give you some relief. After surgery the liquid form of Lever 2000 helped my skin get that funk smell out it. Also, a small amount of the Lever 2000 used as a lotion in my armpit help control the funk smell. I keep a small bottle in my purse and freshen up in the restroom when at work or travelling to eliminate some of the embarrassing smell.
    The grafts that I saw on this website looks excruciating and overkill.

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    1. Unfortunately for me the skin grafts were not overkill and it was the last option as I had already had the wide excision surgeries. However you are right they were pretty painful. I hope you are doing good and your arms are better!

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    2. Angela (Previously Anonymous)May 26, 2013 at 9:18 PM

      Sorry Tracy if I offended you. I didn't mean to. It is not my intent to offend anyone. I only want to offer information from my experiences with Hydradenitis, in hopes that it may help someone. I am mending from my last surgery that I had on April 11th. My arm is still painful but not as painful as it was before I had the core surgically removed.

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    3. You did not offend me :D sorry if my response seemed rude. I was just trying to make it to the point... I should have chose different wording!! I hope you feel better soon!

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  9. So how long was your recovery time? I'm trying to figure it how long I'll need to take off work.

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    1. I had to be off of work for 6 weeks for each surgery. I week of that was spent in the hospital, but I think it depends on your surgeon. A lot of people I know go home after a couple days in the hospital and some stay longer. The total recovery time would also depend on your surgeon, however I feel that for me 6 weeks was adequate. After if fully healed which was about 12 weeks I started working on my range of motion (by myself) which took me another 3 months.

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  10. I have had problems since 1998! I now have a knot the size of a baseball in my groin area! I was just diagnosed with HS 2 weeks ago finally a name to this monster!!! I've been cut on/lance many many times under my breast and groin areas! What should I do what first step to make? Suggestions anything will help!

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  11. HI! I would listen to your doctor and get some course of action planned out for you. Talk to him about the different remedies I talk about in my post because they have worked for some people and may work for you. I recently discovered zinc Oxide works great for the open "weeping" wounds the HS causes so if you have the open wounds I would try that, but still talk to your doctor first. Good luck!

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