Follow up with Vascular surgeon + team

On Monday August 24th,  Jeremy and I took Brigham to his follow up appointment with Sheryl DeSpiegelaere NP in Dr. Akhtar's vascular + vein office. 

We were pleasantly surprised when they let me go in with him. Seriously...such good news and a relief to all of us. 

Getting into the car + traveling was so much easier for Brigham then it was a week ago.  Thank goodness. It was less painful + he could move better. 

During the appointment she removed the 28 staples out of the injury site. It looks so good. He kept the staples to add to the 5 from his head when he was 6 years old.

Some new details we learned from Sheryl (who was in the 6 hour surgery):

He did not code in the OR. However there was 3 times when they were worried he wouldn't make it. His blood pressure got down to 50/20, which is really low. There is also no record of him coding on the life flight. 

Brigham was one of the first femoral artery grafts they have done. We are guessing because most people don't make it to the OR, they bleed out first.

Sheryl personally held her fingers in the opening of his cut artery + vein on the lower part of the wound towards his knee. She said there were 5 of them working on his right leg immediately.

The surgeons wanted to take the grafting vein from the left leg but when they looked at it in the ultrasound it didn't seem big enough or pumping enough blood most likely due to the lack of blood. They took the vein from his inner right leg. It is a vein you can live with out. 

The inner calf fasciotomy is also part of the grafting site and then the incision continues up his leg. They needed 12 inches (1 foot) of the vein to use in grafting the artery + vein. Picture below.

When they cut the outer calf fasciotomy his muscle burst out due to the pressure in his leg. This is the exact reason why they do a fasciotomy...to relieve that pressure so it does not cut off the circulation + cause compartment syndrome. They used a loose braid stitch to keep it somewhat closed for at least the first day.

The initial work injury did not cut all the way to the bone. He cut through 2/3 of his muscle...so not the entire muscle. They tried to match up the 2 sides of the muscle and stitch it but one side had shriveled and they just couldn't match it up.  So they stitched it up the best I could. 

Here you can get a clearer picture of the injury site near his hip. 

FOLLOW UP APPOINTMENTS

Brigham will have check ups with the Vascular doctors 4-5 times in this first year and then annually for several years.

They will do an ultrasound each time to watch the flow of the graft and leg. They want to keep a close eye on the graft for the first year. Watching for any change or concern. 

Sheryl also explained that getting a skin graft on the fasciotomy sites will help him heal quicker and have less risk of infection. The plastic surgeon will be in charge of closing the fasciotomy and any nerve surgery if needed. We see Dr. Agarwal again next week.

SCHOOL ON HOLD

We cancelled Brigham's fall semester yesterday. It took some time for him to decide what to do about school.  With possible surgeries in the future he decided it would be best to skip this semester and start back up in January. This will be a time for healing + strengthening.