Advertisement - Hide this advert





Author Topic: Open Debridement and Proximal Z-plasty  (Read 167743 times)

0 Members and 1 Guest are viewing this topic.

Offline missmyknee

  • SuperKNEEgeek
  • *****
  • *
  • Posts: 2083
  • Liked: 20
  • From the Land of OZ
Re: Open Debridement and Proximal Z-plasty
« Reply #135 on: April 01, 2008, 11:08:58 PM »
Hi All

25 weeks post op open scar tissue removal and proximal z plasties in Oct 07

Today was pre-op appointments with hospital, PT and Dr N. Hospital was uneventful. PT preop went well. I've been thru it so much. Got another pair of compression stockings to add to my collection. PT reconfirmed the scar tissue in the knee. I went up to see Dr N. I had new xrays taken . Dr N came in and I proceeded to tell him about the redevelopment of scar tissue since I saw him in Jan, around and below the patella. I said it was all back where it was removed last Oct. He could definitely feel it and said it would need removal again. We went over the nerve surgery. Fortunately I was having a flare up of the nerve so it made it easy to see and feel where all the neuromas are located. I am really in pain now from all the manipluation to the nerve. This will not be an easy surgery. He said I am running out of options in regards to the nerve.  With all the scar tissue and nerve problem, I will be having a open surgery and scope. He will using my same 6 inch incision plus I might end up with a small incision on the medial side depending on how well they can get to the nerve. I was kind of surprised a scope would be used in addition with a large open surgery. I told you this nerve surgery was not easy. I will be in the hospital overnight and start PT next day at the office. Flexion was measured at 112.

Surgery is at 7:30 so I have to be there at 6am

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 cat

  • SuperKNEEgeek
  • *****
  • *
  • Posts: 1575
  • Liked: 0
Re: Open Debridement and Proximal Z-plasty
« Reply #136 on: April 02, 2008, 01:49:37 AM »
;D ;D Good Luck! ;D ;D
"Miserable malalignment"
 Lateral release, medial reefing, VMO advancement, and TTT-  3/2/04
Screw removal- 5/24/05
Cortisone injection to pes anserine- 7/27/05
Femoral derotation osteotomy, TTT revision- 10/18/07

Offline Janet

  • SuperKNEEgeek
  • *****
  • Posts: 3679
  • Liked: 2
Re: Open Debridement and Proximal Z-plasty
« Reply #137 on: April 02, 2008, 02:34:39 AM »
That's a lot of surgery, Pam. I can't say it enough....Good luck tomorrow!!

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

  • SuperKNEEgeek
  • *****
  • *
  • Posts: 2083
  • Liked: 20
  • From the Land of OZ
Re: Open Debridement and Proximal Z-plasty
« Reply #138 on: April 03, 2008, 07:53:38 PM »
Hi All

Surgery was done yesterday, I got out of the hospital today and did my first PT session at the office, directly from the hospital.

Surgery started with the doctor coming in to mark the areas on my leg where I felt the most nerve pain. The procedure was explained again with it being a combination open surgery and scope. It was explained that there may be the need to make another smaller incision on the far medial side to get to the nerve involvement over there , if they were unable to get to it from the large open incision. Surgery went well. I came out with my leg wrapped from hip to toes. I had enough padding around the knee to where it looked like I had a soccer ball around the knee. During the nerve part of the surgery , they found 5-6 areas on different branches of the nerve that had neuromas. That is alot of neuromas , so no wonder I had so much pain. These areas were cut in half, then they burn the nerve end which then balloons up at the end. Then they bury the nerve end in the muscle. This is to prevent the nerve end from coming alive to grow erratic and become painful. After this was completed, then the scar tissue was addressed. I had scar tissue in the supraptellar and retropatellar areas. These areas were all debrided of scar tissue and synovectomy.

In PT today the huge bulky dressing was removed. Once all the cotton padding came off there was a large area about the size of a softball of bright red bleeding on the 4x4's. My incision was about 7 inches long and was bleeding at the top and the top/outside scope portal was bleeding too. We added several layers of 4x4's because as each layer was added , it would bleed thru, then the compression stocking and full leg ace wrap. My PT didn't want to do much to cause more bleeding. I did heel pumps, calf stretch, ham stretch , SLR. I need help with those as my quad has shut down ( haven't had that happen for a long time), calf raises and foam cylinder squeeze. After that I had e-stem to quad and game ready. They did not want me to come back for an afternoon session. They wanted me to go home to just rest, ice , elevate and do e stem 5-6 times/day. I go back in the morn. Flexion was 80. I am weight bearing as tolerated, but as long as I am oozing/bleeding, I am NWB. No patella mobes yet.....they don't want to stir the knee up with the bleeding. I was placed on Celebrex right after surgery as an anti-inflammatory .

When the dressings were off, I felt around the medial side and I feel completely numb from the far medial over to the halfway mark to patella. I'll take numbness over pain anyday. I have been experiencing some burning pain around the rim of the numb site, but doc felt it was expected for now and would go away.

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 cat

  • SuperKNEEgeek
  • *****
  • *
  • Posts: 1575
  • Liked: 0
Re: Open Debridement and Proximal Z-plasty
« Reply #139 on: April 03, 2008, 11:04:10 PM »
Wow, Pam. Bet you're glad that's over with. Are you feeling okay?  How long did it take to get all those neuromas?
Best wishes for a speedy recovery,
 ;D ;D
"Miserable malalignment"
 Lateral release, medial reefing, VMO advancement, and TTT-  3/2/04
Screw removal- 5/24/05
Cortisone injection to pes anserine- 7/27/05
Femoral derotation osteotomy, TTT revision- 10/18/07

Offline missmyknee

  • SuperKNEEgeek
  • *****
  • *
  • Posts: 2083
  • Liked: 20
  • From the Land of OZ
Re: Open Debridement and Proximal Z-plasty
« Reply #140 on: April 04, 2008, 04:37:36 AM »
Hi Cat

YES ! I am glad it is over !!! I am feeling tired and quite sore. On the neuromas, do you want to know how long the surgery took to remove them ? I think surgery was close to 3 hours long. I was really surprised at the number but that certainly explains how and why I was having so much pain and experiencing so many different nerve symptoms. I have not had any burning today , that I felt yesterday post surgery.I am looking forward to no more burning, needle jabs, sensitivity , throbbing pain. All I feel is numb and it is wonderful. ;D  Also no more scar tissue . Cautiously optimistic and keeping fingers crossed on that aspect of the surgery......unfortunately,I know the nature of the beast too well.   :-\

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

  • SuperKNEEgeek
  • *****
  • Posts: 3679
  • Liked: 2
Re: Open Debridement and Proximal Z-plasty
« Reply #141 on: April 04, 2008, 02:46:44 PM »
Pam:

You're right, no wonder your nerve pain was so bad! I can totally understand taking numb over pain any day. I was that way, too, except I was "numb" because I was so spaced out on meds! Seriously, I'm glad that pain is behind you now.

Now be a good girl and follow all your instructions. 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 cat

  • SuperKNEEgeek
  • *****
  • *
  • Posts: 1575
  • Liked: 0
Re: Open Debridement and Proximal Z-plasty
« Reply #142 on: April 04, 2008, 06:13:55 PM »
3 hours, wow. Wonder what a neuroma looks like... ???
"Miserable malalignment"
 Lateral release, medial reefing, VMO advancement, and TTT-  3/2/04
Screw removal- 5/24/05
Cortisone injection to pes anserine- 7/27/05
Femoral derotation osteotomy, TTT revision- 10/18/07

Offline missmyknee

  • SuperKNEEgeek
  • *****
  • *
  • Posts: 2083
  • Liked: 20
  • From the Land of OZ
Re: Open Debridement and Proximal Z-plasty
« Reply #143 on: April 04, 2008, 07:42:56 PM »
Hi All

Day 2 post-op

Today's PT was another very gentle session. Yesterday I had reported how my dressing change showed saturated gauze with bright red bleeding. When I checked the dressing again at dinner time, once again it was saturated so new pads were applied along with compression stockings and ace wrap. This morn at PT dressing change again showed saturated only mix of bright red blood and fluid. PT was kept to very basic of stretches, heel pumps, assisted SLR, quad set , toe raises and mod gentle ROM, nothing pushed. My leg was then elevated and gameready compression applied. I was told no afternoon PT at the facility but to go back to apt, keep leg elevated, iced, estem . No going out, just keep leg quiet to settle down. No mobes yet, do to the oozing and location, just quad sets, stretches, estem and very gentle ROM. I also need to make sure I monitor temp 2x's /day.


Cat

Neuromas are areas where scar tissue balls up around a nerve , causing compression/squeezing to the nerve. The nerve then sends out nerve ends thru the ball of scar tissue , like spaghetti sticking out, with no purpose, where they become very painful and erradic.  :o

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

  • SuperKNEEgeek
  • *****
  • *
  • Posts: 2083
  • Liked: 20
  • From the Land of OZ
Re: Open Debridement and Proximal Z-plasty
« Reply #144 on: April 08, 2008, 10:34:03 PM »
Hi All

6 days post-op

The bleeding has stopped. Saturday the bleeding and draining had slowed down to only leaving about a quarter size on the gauze pads, Sunday was even less and Monday finally no bleeding or drainage even with PT.

With the bleeding problem finally done and over with, I could not go on to enjoy any peace with this knee. Right after surgery I had felt a little light burning on the far medial side of the knee. I told the Fellow when he visited me in the hospital. I said 2 percosets took it away but would come back when the percosets were wearing off. I just shrugged it off as post surgical trauma. Over the weekend I began experiencing the needle jabs below the patella, the same I had prior to surgery. I had a few on Saturday and again on Sunday. Monday I was back in PT. One particular execise involved using a theraband going around behind the knee with a towel between the band and knee for padding. Then you bend and straighten with the resistance. This exercise caused a rubbing on the medial side. I did OK doing it. This was my last exercise before icing down. When I left PT for lunch, my knee started to have that burning pain again, on the far medial side ,only this time the burning intensity was increasing. It was becoming very uncomfortable, so I started to lightly rub the area. I thought it was very point tender and started to palpate around when I got a horrific nerve pain zinger going across the knee resulting in needle jabs below the patella. I was just sickened . I thought OMG it is back only 5 days post op !!! I went back to do afternoon PT. The nerve had calmed down, so we did very light exercises. Today was clinic day to see the doctor. I told him about the burning post-op, needle jabs and a full blown nerve flare yesterday. He felt it was an irritated nerve from the surgery. You can't do nerve surgery without causing other nearby nerves to get irritated. At this point he feels it will calm down as the knee heals from surgical trauma. He said he did a very thorough surgery and did not see any other nerves needing treatment. If it does not settle soon, I will be going back on Neurontin. I said I would give neurontin another try since this nerve is just irritated as opposed to being a neuroma. I said I would NOT take Lyrica ever again. I am also back to using the TENS on this nerve. The area where he did the nerve work is all numb....I wish it extended further. At this point I wish the whole knee was numb. I am very swollen and black and blue. I am using double compression with compression stocking and full leg ace wrap. Flexion was 103. PT is making sure patella is worked well so I don't stick down in the next 2 weeks. I am doing e-stem 4-5 times day.

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

  • SuperKNEEgeek
  • *****
  • Posts: 3679
  • Liked: 2
Re: Open Debridement and Proximal Z-plasty
« Reply #145 on: April 09, 2008, 04:48:46 PM »
Pam:

I sure hope this is just a fleeting problem and goes away quickly as your knee calms down after surgery. Your flexion sounds really good considering how swollen you are. Keep the faith.

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

  • SuperKNEEgeek
  • *****
  • *
  • Posts: 2083
  • Liked: 20
  • From the Land of OZ
Re: Open Debridement and Proximal Z-plasty
« Reply #146 on: April 12, 2008, 02:11:57 AM »
9 days post op

Thanks Janet for the encouraging words , I need them.

Tomorrow I go home after 2 weeks in Cinci. It will be nice to go home but against what Dr N wants. I have been getting increasingly tight around the patella esp above the patella in the suprapatellar/quad tendon area. My flexion has gone from 115 to 108 and I can't get around on the bike anymore. Patella mobes are decreasing side to side in mobility. I have alot of pudding consistancy swelling. After Dr N examined me yesterday he said I could not leave til this was improved. I have been dealing with very ill mother that was hospitalized while i was here and need to get home. I told him I had to leave. So I hope I don't suffer the consquences of leaving Cinci and PT dept in this critical time. I was put in a soft cast which will provide 3 layers of compression to get the swelling down. I am on double Celebrex and icing most of the time and elevation. I have had extensive patella mobes, stretching, Thomas stretch several times per PT session, bike and 20 min ERMI and passive over pressure manual stretching just to get to 108. I have to return in 2-4 weeks. It is amazing how quickly it all changed and things got tight. It felt like someone shrink wrapped the inside of my knee.

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 QBknee

  • Forum Faithful
  • ****
  • Posts: 187
  • Liked: 0
Re: Open Debridement and Proximal Z-plasty
« Reply #147 on: April 12, 2008, 02:29:22 AM »
Pam,

I have not been on the site in a while and just read up on your latest surgery.  I hope your trip home goes well and the knee continues to calm down. Aside from some of the lingering sore nerve pain, it looks like you have some good ROM without really trying too hard to bend.  Don't forget about your extension!

Best of luck for a full recovery and NO MORE SURGERY.  This is it!

Dan
5/90 - Microfracture, 11/02 - ACI harvesting scope, 09/03 - Bone graft-Scar Resection -10/27/03 - Manip w scope 2/2/05- Posterior Capsular Release, Anterior Interval Release/staph infection, 3/14/05 wash out scope 12/11/06- Scar resection, lat/med releases

Offline NotEnough

  • Regular Poster
  • ***
  • Posts: 75
  • Liked: 0
Re: Open Debridement and Proximal Z-plasty
« Reply #148 on: April 12, 2008, 02:55:48 AM »
Pam,

I'm so sorry to hear that your mom is sick and your knee isn't cooperating during an already difficult time. That's too much to deal with. 

I hope things settle down once you get home. Have a safe trip back.

Sarah
4/07: LR
9/07: MUA, LOA, LR, MR
2/08: LOA, MR
11/08: LOA, Partial menisectomy, Chrondoplasty
6/09: Notchplasty, LOA

Offline skibum9

  • Forum Faithful
  • ****
  • Posts: 373
  • Liked: 0
Re: Open Debridement and Proximal Z-plasty
« Reply #149 on: April 12, 2008, 03:28:15 AM »
Pam

Have a safe journey home. I hope that your knee settles down and you can progress forward on you rehab.

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















support