Saturday, January 14, 2012

The Day of the skin graft

The skin graft procedure was scheduled for March 26, and I was going to be there to observe. There had been a few warm days, but that day was cold and damp (of course!)I went to Heather's first to ride Nikki, then over to Centenary for the procedure. I had a wonderful lesson on Nikki! She was coming back into work slowly, but surely.

The surgery was to be performed in a wash stall, made as "sterile" as possible. The entrance to the barn was blocked, as was the aisle of the barn as it approached the wash stall. Several additional students were there to help Dr. Fugaro and Team Suki.

Suki was brought into the wash stall and sedated. She had a catheter in place for when additional sedatives would be required. Healthy skin plugs were taken from the left side of Suki's neck, then sutured to close the incision areas. The "plugs" were taken using a punch biopsy following the hair being shaved and the skin prepped for surgery. The would would have plugs removed also, and the healthy skin plugs inserted into these holes. Suturing is not required because blood coagulation and wound healing would hold them in place.

As the team began to remove the plugs from the neck, they encountered thicker, scarred skin. While the hair re-growth had looked normal, the skin underneath was thicker and scarred. The skin was functional and healthy, but not ideal to promote skin growth and epithelialization. This would not be suitable for the plugs, so the healthy skin area was smaller than originally anticipated. Two people worked on removing the plugs and suturing the holes, and Dr. Fugaro and an assistant placed the healthy plugs into the smaller holes created on the wound area. Considering the fact that we were working in a barn, the procedure was performed under impressively "sterile" conditions.

The surgery took quite a bit longer than anticipated, and Suki needed additional sedation occasionally. I helped when I could and stayed out of the way when necessary and observed. I am a scientist by trade and education and have performed extensive medical research, so it was difficult for me to keep my hands off! I wanted so much to jump in and help suture and/or remove plugs. The team did a great job! It was a long day, and everyone was tired. Again, everyone had given up their Saturday to do this....I continue to be beyond grateful for their dedication!

The skin graft area, post-op

Area where healthy skin plugs had been removed: the area to the right was too scarred to take plugs and achieve normal growth.

When everything was finished, we dressed Suki in a bandage and her new Sleazy. We were all a bit anxious, I one wanted there to be a big rolling episode!

Post-op in the new Sleazy

I waited until Suki was fully awake before I left. The Team was there to take care of her, but everyone was tired and i wanted to do as much as i could to help. Suki was a star throughout the day. There were times during the surgery when she would start to become a little more aware, but medication was quickly administered. The procedure was impressive and time consuming. I wanted it to be successful for so many reasons: this was the best opportunity for the wound to finally heal. But also so many people had invested time and energy and would continue to do so for the next several weeks. We couldn't even think of sending Suki back to a normal boarding situation until Dr. Fugaro was confident that healing was well progressed. He would check Suki daily, and the team would monitor her several times a day. This was a huge commitment for everyone involved. I would not be out until the following weekend....

January 14, 2012

COLD today! I had a squealing baby Nikki on the lunge, but then she was fine. Tomorrow AM will be colder, but not so bad that we can't endure! Both Suki and Nikki are wearing their heavy Rambo blankets, plus an additional layer for extra warmth. Both girls received hugs and gummies before I left. Suki was out today, but Nikki may not have been...depended on the status of the pastures and paddocks. At Suki's barn they were in smaller paddocks toady, but will probably be out in the fields tomorrow. The drastically fluctuating temperatures makes it difficult to dress them!

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