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Author Topic: Open Debridement and Proximal Z-plasty  (Read 167732 times)

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Offline missmyknee

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Open Debridement and Proximal Z-plasty
« on: October 12, 2007, 12:05:55 AM »
I got released from the hospital at noon after getting my last, 2 hr dose, of Vancomycin. I had the 23 hr stay. Then went over to the doc's office for PT for the rest of the afternoon.  I have all the usual modalities for scar tissue to do.....CPM, e-stem, patella mobes,etc,....doctor wants my husband to do the patella mobes on me, several times day, for 4 weeks. I am on Cipro for 2 weeks, for prophylactic infection protection. Next week I start high dose Celebrex for one week , go off one week, then back on high dose for a week. This is to try and keep inflammation down. I have to have ace compression for 1 week. Lots of icing and elevation. I am quite swollen !! I'll be doing PT 1-2 times day. My flexion was a painful 70 today.

( You can read about the surgery I had in May that led up to these events at )

http://www.kneeguru.co.uk/KNEEtalk/index.php?topic=38179.0

I have a 6 inch incision over the previous incisions. Surgery took about 2 hrs. I had open debridement for anterior, medial, infrapatellar, posterolateral, scar tissue and I also had a proximal Z-plasty , according to the doctor. If I understood this correctly, all the tight proximal tissues,medially and laterally to the patella, ( not the retinaculum ), plus some scar tissue, were resected in a Z fashion to loosen up and reattached in a single layer. We had a nice explaination, complete with drawings of how it was done, from the doc. He said I had alot of scar tissue to debride. Now we are back to keeping it from forming, with fingers crossed. I gathered from the explaination , this procedure is not done very often and given the fact  that the medical staff was learning about this procedure, along with me.

It's good to be out of the hospital and maybe get some decent sleep !! Did not get very good hospital service this time  >:(  Evening shift pretty much dropped the ball on patient care.

Pam
« Last Edit: January 11, 2008, 09:57:49 PM by missmyknee »
4Fx Clsd red
IMrod fib plate
derotate osteotmy tibfib
AF
IPCS patbaja
DeLeeOsteotmy,LOA,LR Zplasty,bongrf,chondrplty
chondrplty,LOA,fatpad remvd
TKR
openLOA,neurectmy,ITB Zplasty,fabela
PLC recon,revison,LOA,synovec
MCL,revison LOA
openLOA,prox Zplasty
openLOA, 6 neuromas excised,synov
3 Fusions

Offline skibum9

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Re: Open Debridement and Proximal Z-plasty
« Reply #1 on: October 12, 2007, 12:52:49 AM »
Hi Pam

Glad to hear that you have been released from the hospital. Sounds like you had quite a bit if scar tissue build up since your surgery in May. What was your flexion at before this surgery?

I have the same sentiment on hospital service when I had the MUA in August. I have a more favorable opinion of the other hospital he uses.

Keep up the work at PT. I hope your husband doesn't have to give up some fishing for patella mobs.

Sharon
11/06 - ORIF left patella
1/07 - wire removal with MUA
2/07 - LOA with MUA
3/07 - diagnosed with AF, patella baja
5/07 - scar tissue removal
7/07 - z-plasty patella tendon lengthening & reconstruction
1/08 - hardware/scar tissue removal
3/09 - scheduled for TKR

Offline Janet

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Re: Open Debridement and Proximal Z-plasty
« Reply #2 on: October 12, 2007, 02:11:41 AM »
Pam:

Thanks for posting. I'm glad you're been sprung from the hospital and hope you can get some good sleep now. You've been through all this before, so you know how hard it is and that there will be ups and downs. Hang in there. Let's pray this is the last surgery for you!

Janet
Torn quad tendon repair & VMO advancement 4/99, MUA with LOA 10/99, Patella baja and arthrofibrosis, LR & medial release & LOA 5/01, LOA & chondroplasty 6/03,TKR on 11/06, MUA 12/06. From perfect knees to a TKR in 7 years, all from a fall on a wet floor...and early undiagnosed scar tissue.

Offline missmyknee

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Re: Open Debridement and Proximal Z-plasty
« Reply #3 on: October 12, 2007, 04:04:00 AM »
Sharon

My flexion before surgery was about 107. I was at 120 when I was 2 weeks post-op from May's surgery. I went down hill after that. I am really sore and tender where all this z plasty took place. It is painful to make a quad contraction and to extend when trying to crutch walk. I am really swollen on the medial side. However, I no longer feel stuck down.

Hahahaha.....my husband fishes when I am on the CPM machine. He caught 5 Bass this eve. He'll get those mobes done.

Janet

Thanks for the good wishes.....that's what I need to hope this doesn't come back.  Last time I knew by 5 weeks post-op.

This gets so old to do.

Pam
4Fx Clsd red
IMrod fib plate
derotate osteotmy tibfib
AF
IPCS patbaja
DeLeeOsteotmy,LOA,LR Zplasty,bongrf,chondrplty
chondrplty,LOA,fatpad remvd
TKR
openLOA,neurectmy,ITB Zplasty,fabela
PLC recon,revison,LOA,synovec
MCL,revison LOA
openLOA,prox Zplasty
openLOA, 6 neuromas excised,synov
3 Fusions

Offline missmyknee

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Re: Open Debridement and Proximal Z-plasty
« Reply #4 on: October 13, 2007, 03:19:33 AM »
Today, I awoke with a temp of 99.4 and some areas of redness to knee. I have a red area the size of a 50 cent piece at the bottom of my incision and several red areas about 2 inches out medially. They thought at first it was from the polar care , but I assured them I had many layers of protection between the polar care and the skin. So they drew lines around the red areas to see if it grows larger and will continue to monitor my temp. You would think with 4 doses of IV vancomycin and also on oral Cipro for 2 weeks, infection risk would be avoided. There is slight drainage from the middle of the incision but for now appears to be straw colored.

PT consists of calf stretches
                    hamstring stretch
                    heel pumps with theraband
                    SLR, supine with 2 pound weight
                    bent leg raise on right side with pillow
                    patella mobes.....lots of them !
                    over pressure flexion
                    foam tube squeeze between legs
                    E-stem
                    Ice
                    CPM

Still very swollen. I am on 1/4 weight bearing with crutches. When the compression ace is done next week, I will be back in my Don Joy defiance brace.

Pam
« Last Edit: October 13, 2007, 05:30:08 PM by missmyknee »
4Fx Clsd red
IMrod fib plate
derotate osteotmy tibfib
AF
IPCS patbaja
DeLeeOsteotmy,LOA,LR Zplasty,bongrf,chondrplty
chondrplty,LOA,fatpad remvd
TKR
openLOA,neurectmy,ITB Zplasty,fabela
PLC recon,revison,LOA,synovec
MCL,revison LOA
openLOA,prox Zplasty
openLOA, 6 neuromas excised,synov
3 Fusions

Offline Janet

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Re: Open Debridement and Proximal Z-plasty
« Reply #5 on: October 14, 2007, 03:11:19 PM »
Oh, Pam, here's hoping you don't have an infection. That would be too much with all you've been through! Please keep us posted.

Janet
Torn quad tendon repair & VMO advancement 4/99, MUA with LOA 10/99, Patella baja and arthrofibrosis, LR & medial release & LOA 5/01, LOA & chondroplasty 6/03,TKR on 11/06, MUA 12/06. From perfect knees to a TKR in 7 years, all from a fall on a wet floor...and early undiagnosed scar tissue.

Offline missmyknee

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Re: Open Debridement and Proximal Z-plasty
« Reply #6 on: October 14, 2007, 04:37:54 PM »
Hi Janet

Yes !!!!  :o   that would be terrible......I am knocking on wood, as I write this. Infection is one thing I have not had to deal with, during any of these surgeries.

Temp seems to be in low 99s  . Still watching the redness and heat...no areas of redness have grown larger. The drainage seems to have stopped.

Pam
4Fx Clsd red
IMrod fib plate
derotate osteotmy tibfib
AF
IPCS patbaja
DeLeeOsteotmy,LOA,LR Zplasty,bongrf,chondrplty
chondrplty,LOA,fatpad remvd
TKR
openLOA,neurectmy,ITB Zplasty,fabela
PLC recon,revison,LOA,synovec
MCL,revison LOA
openLOA,prox Zplasty
openLOA, 6 neuromas excised,synov
3 Fusions

Offline ceoshea

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Re: Open Debridement and Proximal Z-plasty
« Reply #7 on: October 14, 2007, 09:40:58 PM »
Hi Pam:

I've read several of your posts and was wondering if you are from Kansas.  I'm in Wichita and flew to Cincinnati last week to see Dr. Noyes.  I was very impressed, even though I did not like the news he gave me. 
ACLR:  12/30/04
LOA and removal of hardware:  8/05
LOA:  6/06
LOA:  11/06

Offline missmyknee

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Re: Open Debridement and Proximal Z-plasty
« Reply #8 on: October 15, 2007, 02:53:30 AM »
Yes, I'm from Kansas. I live about 25 miles South of KC.

I've been seeing Dr Noyes since 2004. He's done 5 surgeries on me. He's handled several complicated problems I've had, including arthrofibrosis.  I've made about 20 trips to Cinci, since I started seeing him, because I trust no one else with my knee. We usually drive, so it takes about 10 hrs.

Glad you got an opinion with him. If you decide to continue using him, you couldn't be in better hands. His PT staff is excellent. If you need any other info or where to stay, just let me know.

Pam

4Fx Clsd red
IMrod fib plate
derotate osteotmy tibfib
AF
IPCS patbaja
DeLeeOsteotmy,LOA,LR Zplasty,bongrf,chondrplty
chondrplty,LOA,fatpad remvd
TKR
openLOA,neurectmy,ITB Zplasty,fabela
PLC recon,revison,LOA,synovec
MCL,revison LOA
openLOA,prox Zplasty
openLOA, 6 neuromas excised,synov
3 Fusions

Offline missmyknee

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Re: Open Debridement and Proximal Z-plasty
« Reply #9 on: October 15, 2007, 10:38:16 PM »
I am going to PT 2x's /day this week. Today we added the ERMI flexionator ( www.ermiproducts.com ), calf raises and another theraband exercise. Normally , I really like the ERMI for flexion , but today...no. Something caused my knee to puff way out on the medial side, where he did alot of work. It ballooned out so much, I told them it looked like I had sprouted another patella, medially. I only got to a painful , tight, 90 and was also supposed to have the overpressure done for flexion, but had to stop everything after the large amount of swelling appeared. We just went directly to icing and E-stem.

Also had my steri strips changed out. I do have 2 ends of a stitch to be removed later. I was hoping I would be able to finally take a shower. I couldn't because of the drainage earlier. As the steri strip were changed, there were edges that were pulled apart enough to start bleeding, so looks like there's still no shower for now :'( :'(

Hopefully tomorrow things will be better, so I can work on my flexion.  :P   Husband's doing a great job on patella mobes   ;D

Pam
4Fx Clsd red
IMrod fib plate
derotate osteotmy tibfib
AF
IPCS patbaja
DeLeeOsteotmy,LOA,LR Zplasty,bongrf,chondrplty
chondrplty,LOA,fatpad remvd
TKR
openLOA,neurectmy,ITB Zplasty,fabela
PLC recon,revison,LOA,synovec
MCL,revison LOA
openLOA,prox Zplasty
openLOA, 6 neuromas excised,synov
3 Fusions

Offline ceoshea

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Re: Open Debridement and Proximal Z-plasty
« Reply #10 on: October 16, 2007, 05:57:09 AM »
Hi Pam:

I am so glad to hear of your confidence in Dr. Noyes.  I thought I would be seeing him to resolve my problems with my tibia never healing and lack of extension after my ACL reconstruction nearly three years ago, but after he saw the xrays his office took and watched me walk, he told me that I have lost 50% of my joint on the medial side, that I am now bowlegged, and that I need an HTO.  He believes I am rejecting my allograft, so I'll need a biopsy first from a tumor orthopedist to rule out infection, then have the ACL removed and tunnels filled in with a bone graft from my hip (a surgery he'll do) and then in 6 months have the HTO and revision ACL reconstruction.  He said my lack of extension is the least of my problems.  I did not like to hear his diagnosis, but it's a relief to find someone who definitively knows what is going on and that it's not in my head!  No one has ever said that to me, but I start to feel that way sometimes. 

I know that I will have lots of questions about how long I should plan to be away from home, where to stay, etc.  I'm still trying to process all this information.  In the meantime, good luck with your rehab and recovery. 



Cathy
ACLR:  12/30/04
LOA and removal of hardware:  8/05
LOA:  6/06
LOA:  11/06

Offline missmyknee

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Re: Open Debridement and Proximal Z-plasty
« Reply #11 on: October 16, 2007, 10:07:43 PM »
Cathy

You will be in good hands with Dr Noyes. You have alot of work ahead.

When you need some info on where to stay, etc, give me a PM and I will give you some info on short term fully furnished apartments. I am currently staying in one and stayed in one this past May for surgery. I told another kneegeek , Sharon, and she used them too. I can also provide addtional info about Cinci.

Pam
4Fx Clsd red
IMrod fib plate
derotate osteotmy tibfib
AF
IPCS patbaja
DeLeeOsteotmy,LOA,LR Zplasty,bongrf,chondrplty
chondrplty,LOA,fatpad remvd
TKR
openLOA,neurectmy,ITB Zplasty,fabela
PLC recon,revison,LOA,synovec
MCL,revison LOA
openLOA,prox Zplasty
openLOA, 6 neuromas excised,synov
3 Fusions

Offline missmyknee

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Re: Open Debridement and Proximal Z-plasty
« Reply #12 on: October 16, 2007, 10:21:02 PM »
Swelling is still a big issue. Trying some different modalities on e-stem for swelling and pain. Stopped doing the calf raises and back to heel pumps with thereaband. Calf raises were too painful to the lateral and medial tissues. Managed to squeak out a 96 on the ERMI. Patella mobes today produced a painful tissue "POP"   :o ......just a nice little reminder that scar tissue lurks. Doc did his rounds thru PT. He said it would take about 3 mos for the z-plasty areas to calm down.

Pam
4Fx Clsd red
IMrod fib plate
derotate osteotmy tibfib
AF
IPCS patbaja
DeLeeOsteotmy,LOA,LR Zplasty,bongrf,chondrplty
chondrplty,LOA,fatpad remvd
TKR
openLOA,neurectmy,ITB Zplasty,fabela
PLC recon,revison,LOA,synovec
MCL,revison LOA
openLOA,prox Zplasty
openLOA, 6 neuromas excised,synov
3 Fusions

Offline missmyknee

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Re: Open Debridement and Proximal Z-plasty
« Reply #13 on: October 20, 2007, 02:48:39 AM »
9 days post-op......finally took a shower...yipee  ;D

I am down to one more PT session on Saturday morn. Sunday I head home from Cincinnati. It will be sad to leave this excellent PT dept. I can't say enough about them.

PT protocal is essentially the same as posted earlier. I am not doing the ERMI as it causes way too much irritation and swelling to the knee so we are doing the passive overpressure flexion from the therapist, after patella mobes. Flexion is to not be pushed past 90-100 degrees, for the next couple weeks, to keep knee irritation down. The only exercise added was seated leg extension with a half foam bolster under the leg with quad contraction. I am still 25% weight bearing with crutches for several more weeks to keep irrittation down on the knee. Ted hose and compression ace till swelling is down and controlled. CPM was returned today, but still doing e-stem for quad and pain/swelling....lots of ice and elevation. Still on Celebrex for inflammation for next couple weeks. Stitches removed at 2 weeks post-op. All this is done to keep the knee irritation and inflammation down , which keeps scar tissue formation down. Pain is mostly to the medial and patella tendon and some lateral pain. Patella tendon area is a burning pain. Pain  is controlled with ice, elevation, compression and pain meds.

I start hometown PT Monday and see the doc back in Cinn in 6 weeks.  Time will tell if scar tissue returns.

Pam
4Fx Clsd red
IMrod fib plate
derotate osteotmy tibfib
AF
IPCS patbaja
DeLeeOsteotmy,LOA,LR Zplasty,bongrf,chondrplty
chondrplty,LOA,fatpad remvd
TKR
openLOA,neurectmy,ITB Zplasty,fabela
PLC recon,revison,LOA,synovec
MCL,revison LOA
openLOA,prox Zplasty
openLOA, 6 neuromas excised,synov
3 Fusions

Offline Janet

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Re: Open Debridement and Proximal Z-plasty
« Reply #14 on: October 21, 2007, 10:26:21 PM »
Pam:

As much as you hate leaving the good PTs there, I'm sure it will be good to get home. I'm glad you're well enough to make the trip. Hope things continue to go well once you're home.

Janet
Torn quad tendon repair & VMO advancement 4/99, MUA with LOA 10/99, Patella baja and arthrofibrosis, LR & medial release & LOA 5/01, LOA & chondroplasty 6/03,TKR on 11/06, MUA 12/06. From perfect knees to a TKR in 7 years, all from a fall on a wet floor...and early undiagnosed scar tissue.















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