Gracilis Muscle Free Flap

See the heading? Add in a Masseter nerve transfer, as well!

The day of surgery, my mother-in-love and I get trucking at 3:45 in the morning! We arrive to UVA around 5:30ish and we immediately get checked in and, on our way, back we go! Dressing in my super cute hospital gown and now we meet the world and wait.

Before surgery!

When I say everyone came in to see me, I mean everyone and their mother! My anesthesia doctor came to check on me and let me know how things were going to go. Then my doctor, who is absolutely wonderful, came in to see me and draw all over my face! A resident came in as well to mark the thigh they were going to cut into and the side of the face they were going to open up. Another anesthesiologist came in to see me with a 'lidocaine cocktail' soaked in a come shape pile of gauze and explained that she was going to put it into my nostril to get it nice and numbed up because they were putting a breathing tube in my nostril. She began getting my nose nice and prepped with some lidocaine! After a little while, my nose and mouth became numb!

7:30AM comes along and they are off to wheel me back! Once they wheel me into the OR, there were two OR nurses with checklists and calling things out. There were a few anesthesiologists with two anesthesia doctors calling out things on their checklists! I moved over into the bed and laid my head in a nice head rest as these people were still calling things out! I saw a scribe, someone to diligently take notes, and some residents in the room. They hadn't even injected me yet but I was off to sleep.

Later during surgery, I had two surgeons and they each had two doctors with them. At 9:30PM, my husband gets a phone call from my doctor saying that they are wrapping me up in the OR finishing stitches and I'll likely be in recovery for an hour or two and then off to the Neuro IMU by around midnight, and he told my husband that there would be no point in coming since they have visiting hours. I got into a room by 1AM the next day and was checked by two doctors.

In the Neuro IMU, they checked me every four hours! They had a doppler to put on my cheek to listen to the vein and blood vessel connections. It sounded like a little heartbeat and the vein sounds like white noise! Throughout my stay my doctor came to visit me every single day. Surgery was on a Thursday, mind you, and he came to see me every day over that weekend until I was discharged on Sunday.

For one week after surgery, I am to be on a 'no chew' diet. Shakes, applesauce, and soup it is! At the hospital I had pureed food that I didn't mind at all! They were very artsy and had the pureed corn look like corn! I was rather impressed. I spent the course of my hospital stay walking with my walker with nurses, PT & OT, and my husband! The doctors and residents who saw me were all very pleased with my progress. I was pleased too! The nurses came every couple of hours to check on me and put Vaseline on my incisions. They also put an antibiotic ointment in my eye as that area has an incision as well! He placed some muscle under my lower eyelid to raise my eyelid up, so it doesn't droop anymore.

Gauze Catcher!

I had lovely drains coming from my face and neck and gauze in both locations to catch any ooze or blood that came out. I actually had a ton of dry blood clumps in my hair and asked my daytime nurse what I can do to get it all out. She looked at me and said, "one second." Then she came back with a pile of material to work with! She had this folding thing that reminds me of people laying out in the sun and putting this on their chests to get their neck and face. Well, she positioned it around my hairline to try and keep my hair wrapped up. She then made a little soak with warm water and peroxide. But not too much peroxide as she didn't want to bleach my hair! I was thankful for that. She parted my hair and clipped sections back and worked on one small section at a time. She soaked it in water and grabbed a comb and softly combed the dry blood clumps out of my hair. She stated that we wanted to get all of this out because after a few days it starts smelling badly. Can I just say how thankful I am for her?

In my hospital stay I couldn't shower. In fact, I couldn't even shower when I got discharged! My doctor finally gave the okay to have me discharged on Sunday. One of the resident doctors came to see me and she took the drain out of my face and out f my leg! It really wasn't bad. She cut away the stitches holding each drain and pulled the drain out! It actually hurt a lot less than the shots of heparin they had to give me daily in my stomach! The needle part itself didn't hurt, but goodness the bruising that is still there a week later is tender!

PT & OT came to see me one last time to make sure I had everything I needed at home. I let them know I have a walker at home, just in case, I have toilet rails, shower rails and a walk-in shower with a shower chair! They then gave me a Reacher stick and a shoehorn, so I did not have to bend over as much. My nurse went over my discharge paperwork, which states:

• No bending over

• No shower until Tuesday

• 'No chew" diet until a week out

• Put Vaseline on incisions multiple times a day. There's no so thing as overuse here. They need to be kept moist!

• No smoking. And if you smoke: QUIT. I don't smoke so this one was easy for me!

• After two weeks start to apply 30 SPF sunscreen to your incision and avoid over exposure to the sun for the first year.

• Take antibiotics until they are gone

• Take baby aspirin for one month

And I'm sure there were more, but that's all I can remember!

OH, and while I stayed at the hospital I couldn't sleep on pillows! My headrest had to be at 30 degrees, and I had a circular foam thing I could put my head on to sleep. That thing is NOT comfortable! But pillows put you at a great risk for diminished draining and greater bleeding! So, I guess I understand why...but still!

I was then taken downstairs by wheelchair and led to my husband's vehicle. The drive home with bumps was not ideal! But I'm going HOME. While at home, my first shower on Tuesday was heavenly. I stack all of my pillows on top of each other and guess what I put on top...the circular foam thing. I had found that when I'm at an incline I don't have a great deal of pin AND the 'pressure' feeling is minimal!

I do moisturize the crap out of my incisions. Doing this, adding in the sunscreen in a week, eating a very healthy diet, walking daily...this will ALL grant a great success of this surgery sticking and working! I do not want to have another surgery on this side of my face! Will I have this surgery down the road? Yes! I have mixed bilateral facial paralysis.

There is typically 90% chance of success with this surgery: which I'm excited about! I definitely want this to work. I know that there is swelling for the first three months. I won't feel sensation until about 6 months. Then he will put me in facial physical therapy again so I can LEARN how to smile again! Since he used the masseter nerve, I will have to bite down in order to smile! I see my doctor next week for my post-op appointment! There he can look at everything and see how I've progressed and plan on things from there!

Did I mention that I had a resident tell me that my case cannot be found in ANY textbook. I'm a unicorn people! My husband at least called me one when my injury first happened, and they had to put a bolt in my skull, and it stuck out looking like a unicorn horn!

Gracilis Muscle Free Flap

Now I get to wear another visible scar (my trach in my neck is the first scar!) from my temple down past my jaw line and into my neck a little and around my ear!

Here's to praying for many good things to come. Here's to praying for God's strength and wisdom. Here's to following God when he calls.

I'm sure that as time goes on, I will think of other things to add in here. But for now, good night!