Here is a post-surgery report in my first follow-up visit. 10 days post operatively I had my follow-up appointment.
Pain vs. Discomfort
The first 2 days went by quite well with minimal discomfort thanks to the nerve block. It wasn’t until the end of the third day post-op that I had to take a dose of pain medication (Percocet). On two more occasions during the 10-day period I had to take some. It wasn’t so much trying to be a hero or a great aversion to medications. (I do believe that modern medicine exists for a reason and I won’t suffer if I don’t have to.) But, on a scale of 0-10 (0= no pain; 10= excruciating) the discomfort ranged from a high of 7-8 when I had my foot down for long periods of time to a low of 2 when my foot was put up and rested for 15 minutes or so. The swelling and pressure from dependent edema was tough. I got the message fast… keep it up!
More on the Procedure
I arrived at the outpatient surgical center a bit before the 0600 report time (my brother Jim at hand for the ride home). I was off to surgery at 0730. After an IV was put in and I was rolled into the operating room; I rolled onto my stomach on the gurney. The next thing I remember I woke up around 0900.
Oh ya, here is what happened in my hour and half of mental awareness diversion. After an initial incision (8 inches approximately in the lower third of my lower leg) they then opened the tendon sheath to reveal the tendon itself.
After initial inspection, the doc was convinced that a tendon relocation was not indicated and in fact only the debridement and PRP was needed (woohooo!!!!).
For those who aren’t aware debridement is a method of causing repair to tissue and in a way cleaning it up. The do this through microthermal debridement. They make small electric burns in rows up and down the tendon. The burns are spaced a little over a centimeter apart. All sides of the tendon are treated. The device allows for about a centimeter or so deep burn. I’m not sure but I would estimate at least 30-40 burn marks were performed on mine.
Once completed he then sewed up the sheath and skin. It was only 9 stitches. However, they then used Durabond a sterile, liquid, skin adhesive that holds wound edges together eliminating the need for sutures – usually. In my case it was in addition to sutures. Why? It was so that when they injected the plasma nothing would leak out.
They then injected the plasma.
PRP – Plasma Rich Protein is what is called “autologous” or that it originates from yourself not from someone else. It is injected into areas to stimulate your body’s natural healing processes.
PRP is not a single procedure nor is it standardized. They take your own blood and spin it down to reveal the plasma. However, depending on the procedure they are doing depends on how the spin it down. They can do a light spin and get a liquid for larger areas to bathe. The can perform a bit longer spin to get a jelly like substance (or “snot like” as my doc says) for more localized treatments. And finally they can spin it to get “bands” of material. This is used for something like taking it and wrapping a repaired ruptured tendon.
I was given the first option since they wanted to bathe my entire tendon and all the debridement locations. That is why they used the Durabond so as not to let all the plasma to leak out between the sutures. Interesting eh?
Oh and in case you are wondering since this procedure is so new and standards aren’t set it is seldom covered by any insurance. Despite having the rest of the procedure done the PRP portion will be billed – out of pocket expense.
The Follow-Up Appointment
Now, I did do one thing not advised by the doctor during those 10 days. I did remove the wraps and bandages. They began to stink. My nursing instincts took over… smelly bandages is not good. So I changed them 4 times that week.
When I arrived and was in the exam room and before the doc arrived; I quickly removed my boot and wrappings so he wouldn’t know I changed them. I succeeded.
The stitches were removed without incident. I was given a very good report. Healing is progressing normally.
Total boot time is about 6 weeks. The key is to restrict flexion of the ankle and extension of the calf-tendon. We have to allow the tendon to heal. Stretching it would break up the healing taking place. In the past they advocated as much as 3 months in the boot. The reason for the dramatic decrease in time is to decrease atrophy in the calf and still attain most of the strength gain in tendon has already been accomplished.
There you have it a first person account of debridement and PRP. If you have any questions I will be happy to respond.
Late Post Script: I never was billed for the PRP since it was included in the surgery. All other PRP stand-alone procedures are not covered by insurance as reported to me by others.