Saturday, September 24, 2011

Drainage: Day Two

It's been twenty-four hours since we first discovered drainage from two pin sites. Dr. Jeng asked us to send him daily updates, so let's take a look and see where we're at.

The area shown above is the primary area of concern. All of the wires and screws you see here are in close proximity to one another. All of them are in the tibia. And all of them are near the site of a possible future amputation.

After a quick examination, the first thing we noticed was a new, third drainage site. The dressing from last night was stained around this pin on the lateral side of my leg, suggesting the drainage had not stopped since last night. We didn't need to do any squeezing of the skin nearby to produce this drainage. As you can see, this is a slightly different type of fluid draining from the pin site than the other two from yesterday. This pin is on the lateral (outside) of my leg and the most proximal (closest to the core of my body).

Brooke was not too concerned about this new drainage, primarily because of its color and its consistency.

I trust her judgement for a three reasons:
  1. She's my wife and I'm obligated to trust her judgement.
  2. She's been in school for a few years to become a nurse practitioner.
  3. She recently and successfully diagnosed someone with genital warts instead of herpes when the rest of her class group incorrectly believed it to be herpes. I'm not sure how that applies to this situation, but, in my book, her ability to correctly diagnose disease is a good reason to trust her.
The picture above is the most proximal k-wire on the medial side (the small wire at the top of my leg on the inside). After squeezing the skin around the site, the same type of fluid we saw yesterday emerged.

I have been discouraged from referring to this liquid as yogurt.

This site concerns me the most of the other two. There is very little "meat," between the pin site and my tibia -- which means very little tissue for an infection to traverse before reaching the bone.

Same k-wire picture from above but a different angle. This time I made to sure to wear my latex gloves and had Brooke take all of the pictures.

The second-most proximal k-wire on the medial side is also continuing to drain the white, sticky fluid. It's the same amount as yesterday.

The odd thing about trying to squeeze out fluid from this particular pin site is that it feels like a giant reservoir of this fluid is sitting just underneath and around this pin.

Now, I imagine that many of you refused to watch yesterday's drainage video -- because, well, it's gross. I've modified this video a little bit to make it easier to watch.

Make sure your volume is not on mute.

This is probably the first video on the internet of someone draining infected bodily fluids out of a pin site to the tune of Benny Hill.

You might be wondering at this point, "why is his skin brown and disgusting looking?"

You have made a valid point. We've not washed the skin around the pin sites since the surgery on August 15th. Dr. Jeng preferred we keep the site clean with weekly iodine soaked gauze pads.

How does it smell?

Ask Spunky, she's the expert on bad smells.

After seeing the pin site drainage, Dr. Jeng has asked that we revert to the pin site care and management we used last year -- but without using running water. After draining as much fluid as we could, we spent a lot of time cleaning the pins and the skin around each site.

To clean the skin around the pins, we used something called a chlorascrub. It's extremely important to clean the skin around the pin sites. Bacteria love places that never get washed.

Here are a few pictures after we spent some time cleaning the skin. This gives you a more clear indication of how the skin is doing around the sites.

This is the second-most proximal pin site from the medial side after it's been cleaned. The skin around the site still looks good. The skin is also not warm to the touch compared to the rest of my leg, which is always a good indication of no infection.

Here's the same pin site from the top. After cleaning the skin around the site, it looks better. The skin just around the pin is a bit red, but, as Dr. Jeng said yesterday, it isn't angry.

Here's a view from the bottom of the most proximal k-wire on the medial side after it was cleaned with a chlorascrub.

Here's a view from the top of the most proximal k-wire on the medial side after it's been cleaned.

And finally, here's a view of the same proximal k-wire from the lateral side. The skin looks good, which is always a good sign.

Here's a view from a different angle of the lateral side of the proximal k-wire.

After examining the pin sites and cleaning the skin, we wrapped up the area with several two-inch flexible dressings. We've stopped using iodine soaked gauze pads since they could be caustic enough to cause some of the irritation of the sites we're seeing.

The game plan is to continue monitoring the situation until we've finished the Duricef antibiotic run Tuesday morning and to keep in touch with Dr. Jeng.

Brooke and I are going to go back to watching Tulsa get destroyed by Boise St.


  1. The only thing I like about this latest update is the picture of spunky peeking out of the luggage. Very Cute ! I've got my fingers crossed Tony & Brooke. Please Please please --- let this clear up quickly without any more problems. Mom

  2. First thing I'll say: you're lucky that Brooke is a nurse, and that she loves you so much. Draining fluid from wounds is true love. I'm sorry to hear about this new development. Also, we received your funny, guilt-tripping card, and we'll be sending you something sometime. You conveniently scheduled your surgery between all of our summer travels... :)

  3. Hey there... Thanks so much for your blog.

    Here's my story -- Tib/Fib break jumping off a pier in 2001 when I was 17. Four surgeries later and my doc says I have the ankle of an 80 year old. She said she would recommend I have a fusion if I wasn't so young. My pain is pretty under control (I can function most days) but I have really limited ROM. Like between 3 and 5 degrees passive dorsiflexion and 10 or 15 degrees active plantar flexion. The new doc I just saw today said that he would recommend distraction arthroplasty (that's how I found your blog -- journal articles are a bit dry and don't convey some of the important recovery bits). I have read that DA is for folks with decent ROM. What was your ROM before the surgery? I am wondering if I have enough ROM to be a good candidate. I am also struggling with the idea of a long recovery since I'm in the midst of a doctoral program. Any advice/info?

    PLEASE keep posting!


  4. Dear expert snowboarder,
    I'm also thinking about the distraction surgery. I fractured my talus 5 years ago and I recently had my achilles tendon lengthened in hopes that it would allow for more ROM,but instead I just have horrible arthritis pain and I limp constantly. Thank you for your blog! I also have been blogging about my really helps knowing that you aren't alone. Keep up the good work!