The Beginning of the End

Saturday, May 23rd — Yesterday began what I hope and expect will be the last stage of this long problem with my leg infection. Now that it is officially uninfected, and instead classed as a venous leg ulcer, I was eligible to be a candidate for a new and amazing product called APLIGRAF. I described this pretty fully in the last post, so I won’t go over it again.

Apligraf is  intended especially for use with venous leg ulcers like mine, as well as for diabetic foot ulcers. Both of these conditions are very slow-healing and painful. By placing the Apligraf skin on top of the ulcer, once it’s been debrided properly, healing of the ulcer is encouraged and the graft becomes one with the skin bordering the wound.

So there I was, with my pants leg rolled up, the center of attention of five physical therapists (one of whom was my very own Emily, who has followed this wound and cared for it three times a week since the start), including Stacy, otherwise known as The Maggot Lady. A representative from the company that makes Apligraf (Organogenesis) was there to oversee the procedure and offer helpful hints along the way. Apparently this was only the second time they had had a patient at the Mercy clinic who was “suitable” for this product.

It came in a very large box, which turned out to be full of Styrofoam packing and possibly refrigeration — I didn’t get that close a look at the packaging, but it would seem reasonable to refrigerate this stuff. The actual container looked like my hummingbird feeder: a clear plastic, circular dish whose top came off. Inside was what looked exactly like a round piece of SKIN. Apligraf is similar to human skin in that it has two layers — a dermal layer and an epidermal layer. It is dissimilar in that it has no sweat glands, hair follicles, or blood vessels. It was a neutral, Caucasian-hued piece of skin — but one of my favorite things about this stuff is that it has the property of repigmentation. That is, once applied, after several weeks it will take on the coloration of the surrounding skin. Thus, even in a person of color, eventually there will be no demarcation between the graft and the rest of the person’s skin! Isn’t that astounding? I love it! Just another instance of how it grows to become one with the recipient…

Emily had to tweeze out a few bits of hypergranulated tissue, since the Wound-Vac had done such a superb job of growing new tissue in the wound. In a few places, the new stuff had grown just a tiny bit above surface level. The skin wouldn’t adhere well if the base was lumpy, so to speak, so that had to be tweezed, swabbed with silver nitrate (which, in effect, burned the extra bits), and then scrubbed off.  I popped another Norco and felt better. Then she washed off the surrounding area, and we were ready to roll.

First she placed a piece of gauze, wetted with saline, over the graft, covering the epidermal side. Then she picked the gauze and the graft up with large tweezers — “Don’t worry about hurting it, it’s really tough stuff, just grab hold of it!” advised Angela, the company rep — and flipped it over into the top of the container. Now the underside, the dermal side, was facing up. Next she picked it up by the gauze-covered edge and flipped it again, this time onto the wound.  She removed the gauze with the tweezers and smoothed out the skin with the backside of the tweezers and a gloved finger. The piece of Apligraf was just a little bigger all around than my wound had been.

Emily placed Steri-Strips in a rectangular “frame” on the edges of the Apligraf, to hold it in place. An absorbent foam dressing was put on top of it and Steri-stripped down as well. Angela instructed me, “You’re never to lift this up. Don’t peek at the skin! You can change the dressings every day or two above this level, whenever you notice drainage; but DO NOT remove this part. When you come back here in a couple of weeks, after you return from Boston, Emily will take it off and check to make sure everything is okay.”

(I forgot to mention that I am flying away to Boston on Thursday, to spend 12 days with my daughter, her husband, and the two little grandboys — and to attend a bit of my 50th Harvard/Radcliffe reunion! The timing really was pretty good, what with winding up the Wound-Vac and applying the Apligraf and all.)

More absorbent padding and some of that self-adhering gauze bandage wrap finished the dressing. Then came the footless jersey stocking that goes under the Circ-Aid, the Velcro octopus that encircles my calf and provides compression. And finally, the Circ-Aid itself, to top off the whole concoction.

The Circ-Aid, by the way, is quite comfortable, and rather amazing in its own right. It’s based on The Giraffe! The giraffe has those spindly little legs that look like deer-legs, and he’s on his feet 24/7, since giraffes sleep standing up. Why doesn’t he have all kinds of lymphatic problems? Why doesn’t he have circulatory problems? We get them when we’re on our feet too long, or sitting down for long periods of time — why not the giraffe? Answer: because the skin on the giraffe’s legs is not elastic! Somebody observed this, and was inspired to create the Circ-Aid, which also provides circular leg compression with non-elastic material!

So I am ready to go to Boston. My daughter will help me with winding up my leg in bandages and putting on the Circ-Aid… but apart from that, we are going to have a lot of fun. I haven’t seen her or the kids for a whole year, since my birthday party in Toronto last Memorial Day weekend. Hayes will be three in July, and Johnston will be six in November. I can’t wait! My son-in-law, Chris, has already planned to babysit one night so that Sarah and I can go see the new Star Trek movie together. That’s one of the myriad reasons I adore Chris.

I’ll report to you when I return. I have one more session with David Klein on Wednesday, to get my spine ready for the trip. I’m so glad I will probably be able to resume my three-times-a-week at Seaside when I get back. The Skin and the Circ-Aid won’t need to go to the clinic as often as the Wound-Vac did; maybe I can manage with once weekly. We shall see.

Up, up and away… thanks for reading — Betsy