EK here. It was a long surgery yesterday, but they accomplished what they wanted to, which was to get the "free flap" in place and hooked up to good blood supply. (Lex and Ebby are with her in Nashville right now, I'm in Portland with the boys.)
Surgery started yesterday around 1030 a.m. and ended after midnight; around 14 hours. Sareana is pretty beat up, but they say she is doing as well as can be expected at this point after such a procedure. She's still pretty groggy and hooked up to a lot of tubes for the usual stuff: hydration/nutrition, painkillers, antibiotic, drainage, etc. It was in many ways a more involved and invasive procedure than anything she's had done prior, so the recovery period will take longer.
The first part of the procedure was done by neurosurgery, who removed all existing hardware (mesh, screws, etc), glue, and some dead bone. This all went smoothly. They found evidence of infection and fungus, which was all removed and cleaned out, and which has been sent to Infectious Diseases for identification and will then be specifically targeted with antibiotics. Unlike previous surgeries, they removed everything foreign without replacing it; she'll have a little "soft spot" in her skull, which is apparently not a big deal. More importantly, removing anything foreign gives a much improved chance of successfully getting rid of infection. I am hopeful that the existence of infection was responsible for at least some of her symptoms, and that it's removal will help her feel a bit better in some regards.
The next part of the procedure was done by plastic surgery, who took a "flap" from her thigh and then incorporated it into the back of her head to fully close the wound. This was met with some difficulty, which is why the surgery took so long. Part of the procedure involves hooking up an artery and veins in this flap to an existing artery and veins in her head. I'm told the artery is about the size of the tip of a pen, and the smallest veins they hook up are almost thread-sized. They join them and then suture them together. All this is understandably time-consuming. The veins were fine, but the artery was a problem. The artery they originally hooked up to is in the neck, and each time they hooked it up, it would clot and they'd have to redo it. After several tries (and many hours), they went to Plan B, which was to hook up to an artery that runs just in front of the ear. In order to do this, they needed more tubing (ie vein/artery), so they had to go back to her leg, which was at this point already sewn up, and reopen to get more material. Eventually, they successfully hooked up to this other artery and were then able to finish the procedure.
The tricky part is making sure that the blood supply continues to flow properly through these new hook-ups, and they are watching very closely for any signs of clogging or clotting over the next few days. Every hour that goes by without any problems is good, and improves the chances that it will keep working, until after 3 or 4 days, if all still looks good, they'll be confident that it "took". In the meantime, if it quits working or clots, they will need to immediately take Sareana back to the Operating Room and try to get it going again. So, we're not out of the woods yet, and are keeping our fingers crossed that this thing keeps working.
That's it for now, I will do my best to keep you updated if anything changes. In any case, I'll try to post something this weekend with a progress report. Thanks for all your prayers and good vibes, they're always appreciated.
EK
