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This is my arm during the 2nd surgery, 36 hours after the bite. You can see how unhealthy all the tissue is.
This is my hand, also during the 2nd surgery. There is a lot of dead tissue in the palm.
This is my hand during the 5th surgery, on Day 12. As you can see, there is still a substantial amount of dead tissue in the palm, but noticeable progress on cleaning it out has been made. The surgeons have started the long process of closing the hand, using staples and rubber bands.
This is my hand during the 8th surgery, on Day 23. You can see the healthy muscle tissue in the arm. One tendon is exposed in my hand, which the surgeons are worried might be a problem for the skin graft that is to be performed in the next week. This is because skin grafts don’t attach well to tendons, but they attach very well to muscle and other soft tissue.
This is my arm during the 9th surgery, on Day 26. This is the last surgery before the skin graft, so the surgeons want to close up the arm as much as possible. You can see the skin being pulled closed by staples and rubber bands.
This is my hand, also during the 9th surgery. You can see that the exposed tendon has been partially covered since the last surgery, which the surgeons were very happy with. To accomplish this, the surgeons pulled my thumb in during the surgery, and used the extra skin this gave them to further close the palm, and the plan was to do a follow-up surgery some time later to bring the thumb back out in some way. You can also see the stitches on the bottom of my palm, which have now been put in further up into my palm, also helping to cover part of the exposed tendon.
This is my arm during the 10th surgery, on Day 30. This surgery was the one in which the skin grafting was performed, and you can see the fresh skin that has been stapled to my arm. This skin was taken from my thigh. Holes were put in it in order to allow blood to flow onto the skin so it could attach to the tissue beneath it.
This is my hand, also during the 10th surgery. The skin graft in the palm was taken from my inner thigh/groin area.
This is the skin graft on my arm after 5 days, on Day 35, right before I was released from the hospital. You can see the holes have begun to fill in with tissue and the edges of the graft are starting to attach to the surrounding skin.
This is the graft in my hand, also after 5 days, on Day 35. It is difficult to see in the picture, but there is a small hole at the very bottom of the graft where is did not “take”, which is what surgeons call it when a graft attaches to the existing skin in an area. A small amount of the graft not taking is to be expected, and it is not a big deal; the hand just needed to stay wrapped to prevent infection for a week after this until the hole filled in.
This is my arm 5 months after the graph, in December 2002. You can see that the holes that were in the graft are completely filled and the graft blends in with the surrounding skin much better.
This is my hand, also in December 2002 after 5 months. Note that although the skin graft in the palm is fully healed, physical therapy has done very little to bring out my thumb from its position, a position which made it very difficult to use my hand for pinching and other actions involving the thumb. This led us to schedule the follow-up surgery to bring the thumb out to its correct position, and after finding out about all the possible procedures and locations for the surgery, we made the decision to have a scapular vascular flap performed by the #1 vascular flap surgeon in the country at Duke University Medical Center.
This is my hand 3 days after the vascular flap surgery in the Duke Hospital. The surgeons took that chunk of skin and muscle from my back, attached its artery and vein using microsurgery, and then stitched it to my arm. During this surgery, the old skin graft in the palm of my hand was taken out. The surgery took 6 hours, which included a tenolysis, a process where they cleaned out the scar tissue around my tendons, improving the range of motion of my fingers. This procedure also meant that I needed to do very intense physical therapy for approximately 2 weeks following it so that scar tissue did not grow back around my tendons. You can see a small section of black tissue below the flap; this is just where there was some blood clotting, causing the tissue to die, and over the following month new tissue grew to replace the dead tissue, leaving no permanent damage.
This is a picture of my arm taken in April 2004, 22 months after the bite and 15 months after the vascular flap was performed at Duke. It is clear that all the problems have been overcome, and both the skin graft and the flap look much more a natural part of the arm than before. Although it cannot be seen from the picture, my fingers and wrist now have full range of motion.