Day 28 - Surgery the 8th

Today's surgery picks up from yesterday. The plan is to autograft skin harvested from his scalp to his chin, throat and neck down as far as they have skin to reap. For this grafting near his face Dr. Wi. doesn't mesh the skin or stretch it. Instead he grafts it nicely in a 1:1 fashion as that gives greater range of movement and looks loads better once healed. With the thicker skin there's a greater chance of it not taking hold and other issues with binding, but Dr. Wi. knows his stuff.

The surgery was planned to begin at 7:30 this morning and last 3 hours, but was delayed until they could get a special probe installed in his esophagus... so new official start time was just after 9am. The surgery finished up around 3pm. Dr. Wi. took his time, left no stone unturned. Since the graft was for his face and neck he took more time to ensure it was perfect. So a 3 hour surgery continued on into 6 hours!

The burns required more grafting to his cheek and chin than planned. They used all the skin from his scalp for the upper areas, then nabbed some fresh skin from his left leg for the neck and area around his clavicle. Dr. Wi. showed us some photos before and after the grafting. It's so impressive what they accomplished. The difference is amazing.

Once all the grafting around his neck is in place then they pack the area with sterilized stem-cells derived from amniotic fluid that has super enhanced "specialness" to promote healing. Then they create a bolster and stitch it in place and keep the area immobile for about 5 days while (we hope) it heals and all the graft area takes hold. The next few days will have Daniel recovering with no surgeries planned until next week or later.

Daniel did his part by being the model patient and is in recovery in his room now. Normally surgery patients recover down in the surgery recovery area, but Burn ICU patients are rushed back to the ICU Burn floor where the burn team can treat him with extra special care.

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In other news I've been reading about the effects of micro-gravity on the body as it can have similar consequences to what happens to one's body in long-term bed rest on the musculoskeletal system. One of these things that happens in both cases is the unrelenting losses in calcium and nitrogen. The Soviet and American space programs tracked astronauts before, during and after space missions and learned a great deal about how inactivity and micro-gravity are similar in how they deplete the body over time.

Back to calcium and nitrogen loss: in long-term bed rest cases as with astronauts the inactivity (or simulated inactivity in micro-gravity) can lead to kidney stones as one concern. Keeping fluid intake high during and after bed rest can help reduce the chance of different kinds of kidney stones for patients.

I'm listening to the morning rounds discussions slightly differently and am beginning to understand why they track his K (potassium), weight, his urine output, stools and blood platelet counts - to name a few.

All of the chemistry goin on in his body can effect different systems in the Daniel-tron unit. It's yet another reason that explains why he's in the ICU. Burns are nasty on so many levels: (I'm missing a lot, but for starters...)

• Skin tissue care - grafting, donor sites
• Internal organ strain and damage
• Muscle and tendon atrophy
• Eye damage (not so mucn in his case, but he's been getting eye drops and salves every day)
• Blood and body chemistry
• Urine and stool output
• Nutrition - he's ramped up to 8,000 calories every day, but will drop back down to 6400 after a few day. That's to make up for the two days were he couldn't eat during surgery .
• Infection - on skin, pneumonia, organs, blood, UTIs, 
• Pain management

Still even after a month in ICU, I'm just barely comprehending how hard of an injury this burn is on his body!