The boy is about 22 yo and I saw him yesterday afternoon and they were thinking of adding him on since we appeared to be done a little early. He had a hemangioma (mass of large blood vessels) on his inner thing that was about 4×10 inches. Some of the blood vessels were as large as my fingers. i said he should be the first case in the morning as it could be very hard to do. So this morning is the day. I ask him about how long this has been there as he lays on the OR table. It been present since birth and has slowly grown larger and larger. He says it hurts. I can imagine if it grew quickly it would hurt but not at a slow progression. That matter not- Im taking it off today. I scrub with one of the local docs who is doing surgery learning for 6 months. I start cutting around it and right away get into a few vessels. This gets my heart rate going. im trying to explain how he can help me and im finding it challenging. He isn’t really a good assistant. I need someone who knows what they’re doing. Dr. Steven comes in to check on me and I ask him to help. Then it goes much better. We are able to go back and forth whichever of us has an easier angle to dissect and the other of us cuts with cautery or ties a small vessel. We slowly peel it up including the underlying fascia or just above that. We finally define that it only had two small feeding veins. These were tied and it is off. Now how to close. I pull on the skin and realize I may be able to get it together with a lot of tension. So I start in the middle with a stitch, then in-between with more stitches. Until with about 30 stitches it all comes together. I’m glad to have gotten it together.
I do another surgery and then the third one is interesting too. This kid of about 8, had an infection going on in his leg for the past 8 months. It was painful and it had some draining pus that came out in different areas. The X-ray showed osteomyelitis (infected bone). This looked like a huge fat bone in the leg at least twice the size of a normal tibia bone. So i took him to the OR to drain it. I cut down to the involucrum (new bone growth around a dead piece of bone (sequestrum). I follow one of the holes that has pus coming out of it and find the hole in the involucrum. I use a rongur to eat the hole away till it’s very wide. I probe inside the bone in both directions. I get a lot of granulation tissue but not any dead bone. I follow another in the upper tibia and do the same thing. In that one I find a small piece of bone. It feels slightly mobile. I wiggle and try to pull on it. I think this is likely the sequestrum. I bite it in half with the rongur. Then one end I grab and am able to wiggle and twist it free. Yep it’s a sequestrum in the dead bone inside. The other end slides up into the top of the tibia. I use a curette and try to swipe it out. Finally i get a hold of it. It doesn’t want to come out, but with force it does. So at least two chunks of dead bone, the source of all this pus is out! i hope there isn’t more, but I can’f find more so i pack the holes down the center of the marrow after washing it with dilute bleach solution. He will likely be here months with packing his legs.
