[olePigeon]

Make sure you keep on that infection, those can get bad really quick. I'm not kidding when I say they could end up taking your whole foot off. Anything abnormal, see your doctor right quick.

[RAILhead]

Okay guys, I'm back.

First off, the infection: the redness is still there, and the fluid buildup and hematoma are there — but I haven't run any fever since Friday night. The Doc flat-out told me that I may not have really had any infection at all to begin with, and the redness, etc., could be nothing more than my body healing and reacting and bruising. I AM continuing the meds, though, and if I start to have a fever of 100.5° or more, I'll go in.

The toe: everything looks great! He said I seem to be a quick healer, so that's nice. It's now wrapped in Steri-Strips as a precaution, and those are to come off in a week. I'm still supposed to take it easy, of course, and listen to my body/toe dictate how much I do. I walked around with just my cane today, and it tired-out my bum leg pretty major — but it's good to feel the muscles getting a full workout. I'll probably go back to my single crutch so that I don't stress things too much too quickly.

And now, here's a pic from today:

[The Placid Casual]

Glad to hear that it all went positively!

It looks like they did an awesome job on patching up your toe, well, in comparison to my chainsawed arm (as per my thread of a few weeks ago)!

I initially had the sutures removed about 6 days after the accident, and it turns out that they had not been put on 100% close enough when they were redone by the doctor. Healing by secondary intention had begun to kick in where it had closed, but it was pretty nicely open :/

I had the sutures redone, and removed yesterday: to find a nicely closed, but hugely purple and jagged line across my forearm, where things seem to have healed a little by themselves, but with a little help of the sutures.

Not pretty. Makes me realise just how good your surgeons were in removing the toe, and also doing a 'Saville Row' standard of stitching it back up!

[RAILhead]

Yeah, I'm anxious to get a good look at it — I didn't really see it before the Steri-Strips went on.

My wife said it was pretty "nasty" because of the dried blood, skin, and scabbing — but I assured her that will all wash off nicely once the strips come off and I can get my naked toe in the shower a couple of times.

[RAILhead]

Man, for some crazy reason my toe hurts more, and is more sensitive, now that the sutures are out. I'm back to using crutches, even.

[RAILhead]

Okay Glenn et al, here's another question I can't find any info online about (that was a horrible sentence, but you got my drift)...

Not to be gross (?), but the skin all around my toe has started peeling.Now, I know the skin around the incision will peel, but I'm talking like down to the top of my foot, down the side, and around and underneath my toe. It's quite literally like the shedding of a snakeskin (it doesn't look that way -- it's not gross or anything), like my toe is molting.

Also, it would make sense if the areas had been bandaged or wet or something like that -- but my toe hasn't been bandaged in weeks, and again, I'm talking about my whole toe, all the way to the top of the main joint on my foot.

Further, it's somewhat thick skin, like a blister -- but the skin underneath is brand new, soft, and supple (if I may say so myself). It's just like a sunburn peeling off...

Why does the body do this? Any ideas?

[ghporter]

This is a response to the immune system shifting gears-twice. Starting from the "we have a problem with a bunch of rogue cells" state, your immune system went into "OMG we've had surgery!!!!" mode and began a generalized healing response. Now, it's shifted into a more gentle and focused healing response, so the built up extra skin thickness over the last while is no longer needed and it's being sloughed off. This is not uncommon after surgery of this type, and you'll wind up with basically the same age skin over the entire foot when it's done, to include the healed toe.

The immune system is VERY effective, but it's not at all discriminating. The way it works is well described with an analogy. Say your street has a pot hole. Public works will come out and maybe clean up the edges of the pot hole, then fill it, maybe even filling the road base at the bottom if it needs it, then resurface the thing and they're done. If your immune system were fixing that pot hole, it would tear up the whole block, curb to curb, all the way down to the road base (or deeper) and then completely repave-covering manholes, storm drains, and everything else in the process.

This is one reason your surgeon and your rehab team will have you start moving EVERYTHING in that limb in all possible directions (if they haven't already had you start). Healing is stupid simple and will heal things together that don't go together. You'll probably be doing toe extension exercises, especially on the residual toe, to prevent the remaining tendons and ligaments from being scared down.

[JoshuaZ]

I met a diver in thailand who had his thumb bitten off by a moray eel, and then had his thumb replaced by a toe.

Your pictures reminded me of that.

There is a video of that as well. Thank goodness someone was videoing that accident of nature.

YouTube - Eel Bites Off Divers Thumb

[RAILhead]

I haven't forgotten this thread, it's just that I'm waiting for the final scabbing and peeling to finish so that I can show the healed incision. There's only about 1/3 of the scabbing left, and the newly exposed, healed incision looks wonderfully pink, fresh, new, and smooth. I'm guessing it'll all be off in another couple of days.

Stay tuned...

[RAILhead]

Ahh, to heck with it. Seeing the scabbing and peeling can't be any worse that the first pics, can it?



Looks pretty good! It's taking every fiber of my being to not yank off the dead skin, but I shan't...

[Mrjinglesusa]

This thread is really disgusting....yet I can't stop from coming back to check and see how your toe is doing.

Glad to hear everything went well and the healing process looks to be absolute perfection.

[ghporter]

That's a pretty well-healed wound, Maury. It's progressing nicely. The redness is obviously much less now. How's the swelling going?

[RAILhead]

Swelling is a LOT better, overall. I'm benchmarking by trying on my good ol' house shoes. They're molded, so they don't stretch, and a week ago, I couldn't even 1/3 of my foot through — but now I can slide it on. It's still too tight to be comfortable, so I'm not wearing it, but I can at least fit into it. Here's a lo-fi iPhone shot trying to show side-by-side, which shows my right foot to be around 5% bigger:



The bruising is reducing, too, to where I'm mainly feeling it right under the joint, only. I'm also off my pain meds as of Thursday night, only taking 1 when I go to sleep. I'll probably try to avoid that tonight, if I can.

The leg is still pretty sore from the lymph node biopsy, but not so much that I need pain pills for it.

[ghporter]

I'd suggest that you can expect the leg and groin incisions to be more uncomfortable for longer than the toe is uncomfortable. It's in part due to the way the nerves are arrayed, and in part because foot and toe tissues are well suited to dealing with "insults" like surgery, while the back of the knee and the "sensitive groin area" lack the protection of thick skin and are thus very sensitive.

Are you still seeing bruising at the top of your heel (which I think I see in the picture)? That's just pooling of leakage, and it's because you have been appropriately propping your foot toes up. That'll go away slowly as the old blood is cleaned up by the immune system-which also means you'll continue to have some swelling and redness for quite some time.

[RAILhead]

Looking good, people! Here are a couple of shots from this morning, which is Day 34...

[tooki]

Looks great! (And 50% less ingrown toenail to worry about!)

[RAILhead]

Well, here's another update. Things have been going great until 2 days ago, when a little bump started forming on the left edge of my incision (where a suture was, I believe). Last night I noticed more bumps forming, and they're still present as of this morning. Here's a pic:



They are more red in person, too. I emailed the PA, and he said:

"This looks like either a suture abscess or a small seroma. Both are very common. If it is soft and non-painful it is likely resolving on its own. I would have you watch the area. If you see worsening signs of infection or if the lump becomes larger you should consider coming in to have us take a look. Try cold compress on the toe for a few days which may help the bump resolve a little faster."

WHEN CAN A BROTHER CATCH A BREAK?!?!?

Ugh...

[ghporter]

Originally Posted by RAILhead 

WHEN CAN A BROTHER CATCH A BREAK?!?!?

In 6-8 months post-op. Or thereabouts. This is a VERY fresh surgery, and your immune system is still dug in and fighting the good fight. But remember that your immune system is also dumber than dumb; remember my analogy to street repairs? To fix a small pot hole your immune system wants to tear up the whole block down to paving base. So that's why you're getting all this stuff happening. And whether they're little abscesses or seromas, it doesn't really matter if they do indeed begin resolving themselves soon. You're noticing them more because you're photographing them, so small changes that happen over time are more obvious to you.

Now if they get to be painful or significantly change color (either much redder or turning white) get to the MD NOW. But it's not likely that's the case.

[RAILhead]

Well, I'm going in to MDACC tomorrow. The discomfort is getting slightly worse, though it's still not bad, per se. BUT, one of the areas where I believe they had a suture -- and not one of the areas I just posted about -- started oozing orangish/yellow fluid ever so slightly when I walk.

Always wanting to be better safe than sorry, I just want to have them look at it. Based on the color and lack of of infection signs, I'm hoping this is just more evidence that it's a seroma.

Ugh.


UPDATE:
A little white bit of suture, about 1/16" to 2/32" worked it's way out of the oozing spot in question. It was "white" like the sutures I've seen as my arm heals, and I'm calling it a suture based on how it felt as I tried to pull it apart, mash it, etc. It was more resilient than some odd piece of skin or something — so I'm sticking with suture.

When the first bump appeared, I said it was probably a suture trying to work it's way out — and that may still be the case. A new, little bump has appeared next to the large original bump, and I'm wagering that a suture bit is beneath the surface there, as well.

Regardless, I am going in to the Doc tomorrow — but this kinda-sorta makes me feel a wee bit better about hopefully not having an infection or abscess.

[ghporter]

Good choice. Better safe than sorry and all that. It IS probably nothing, but having someone with experience and deep knowledge checking it out and telling you that is a Very Good Thing.

[Brien]

So... how's the toe?