The San Andreas Fault on my Arm

Today was not a pretty standard day of appointments at the old Cleveland Clinic. I was there pretty early to get my arm x-rayed in advance of my post-op assessment with Dr. N. The x-rays were the easy part. They began with delicious coffee and ended with more delicious coffee before I headed up to Floor 4 at the Crile Building to see Dr. N and his really fun staff of assistants and nurses. 

One of the nurses (Kristi) came in quite cheerfully and we had a nice conversation about my surgery. I told her what I remembered of it after she asked if I would like a printed out report of the procedure. We both laughed about it. I thought that would be nice since I don't like to have any gaps in my memory of these proceedings. I live under the belief that someone might benefit from the things I know or just have a morbid curiosity of the cutting. 

The procedure began by making a 20 cm incision over the anterolateral lateral arm beginning at the elbow flexion crease and extending up to the to the deltoid tuberosity. Sharp dissection was carried down through the skin and subcutaneous tissue to the level of the biceps fascia. The biceps fascia was incised in line with the skin incision to raise full-thickness fasciocutaneous flaps. The biceps was retracted medially and median nerve was visualized for protection. The radial nerve was identified and the interval between the brachioradialis and brachialis and traced distally and proximally to ensure it was protected along the course. The brachialis musculature was split at the lateral 40%-medial 60% interval to expose the underlying humerus. The cortex was intact throughout the anterior humeral diaphysis. The lesion was locaized radiographically and an 8 hole 4.5 mm narrow LC-DCP plate was set up on the bone. Radiographic images were then obtained to ensure adequate plate length to achieve cortical stabilization proximal and distal to the lesion. The plate was then contoured with a tabletop bending press to match the distal metaphyseal flare. It was fixed to the bone to span the defect with 4.5 mm cortical screws. 3 bicortical screws were placed in the proximal most 3 holes, and the distal most 3 holes. All screws were placed using standard AO technique. All achieved excellent purchase. Final fluoroscopic images confirmed excellent position of the plate and appropriate screw length. No screws were traversing the lesion.

The wound was irrigated with 1 L of normal saline by bulb irrigation. The wound was closed with 0 Vicryl figure-of-eight sutures on the fascia, 2-0 Monocryl in the deep dermis and staples on the skin. A sterile dressing consisting of Aquasol was placed on the surgical site. A final sponge and needle count was correct. The patient was awoken from anesthesia and transferred to the hospital gurney and to the recovery room in stable condition.

Ouch. So now you know as much as I do about the surgery itself.

Anyhow, Kristi finished up and said Mike and Bob would be in to remove the staples. That was when I thought it would be a great opportunity to snap a photo of the wound and the staples. Please enjoy!

I feel pretty. Pretty badass!

 

The San Andreas Fault

Bob and Mike came in and we also laughed about things...including the San Andreas Fault on my arm. Bob asked about the tattoo, which he suspected was a Star Wars thing, and so I told him. Um--if you haven't heard about the tattoo, I can cross-reference my other blog at this moment for you (This Thing On My Arm...). So, Mike, also amused by the story of the tattoo said that "these aren't the droids you're looking for" is a favourite phrase of theirs in the surgical oncology unit and that they use it when they aren't getting the specific answers they are looking for while speaking to colleagues. I thought it was cute. We all laughed and then they left to find their next subject.

Kristi returned with Dr. N, who told me that my arm looked amazing, that my range of motion was amazing and that I would probably be starting radiation next week. We'd discussed the option of Dr. K at the Moll Pavilion at Fairview Hospital as that is where I had it the last time. Since it was going to be a Monday-Friday for at least two week scenario, we decided it would be best to have it closer to where I work even though I liked Dr. K very much. It's OK, I will undoubtedly like the doctor at Hillcrest as well and if I don't, brace yourselves for that story.

I have a follow up with Dr. N in six weeks and I was told that I would be able to lift heavy weights at the gym again in about 2 to 3 months. He also added that I could go back there to do cardio as soon as I would like. I would like to go tomorrow, thank you.