Second Surgery - This seems familiar…

I’m one day post-op from my second surgery now. I have this definite feeling of “deja vu.”

Leading up to the surgery, I had asked my surgeon a few questions about the new rupture:
1. I was wondering there are any theories as to what might have caused the new tear. Do I have a personal predisposition for these injuries? Was it some issue when being placed in the boot? Was there some complication of the original surgery? I know there can’t be a definitive answer to this question, but I was hoping to hear if there are any possible explanations.
2. What are the plans for the new surgery? Are there specific techniques/approaches that are being considered? The new tear appears to be higher than the previous one, and also appears to be incomplete. Does that influence the surgery?
3. I’m not leaning away from surgery, but for completeness’ sake are there other treatment options than surgery? If so, what makes them inferior to surgery?
4. How does the fact that I just had a repair influence this surgery? Any additional risks of complications? Any risks for the outcome for the tendon?

I asked these questions via the hospital’s secure email system, and to her credit, my Doctor called me back the following day with some answers. Unfortunately, as probably is to be expected, the answers didn’t clear things up as much as I’d hoped.
For question #1, she basically didn’t have many theories - she said that she’d be able to see more when she did the surgery - the MRI gave some idea as to what was going on, but there was a lot of scarring from the first surgery (normal), so it was hard to see exactly what was going on.
For #2, she said she’d basically use the same technique as for the first - rejoining the tendon. I asked her if there was a specific technique that she used, and she said she used a Krackow stitch (which I later Googled - it appears to be used in a large percentage of Achilles repairs). She mentioned that they used the strongest sutures available (I think they’re actually steel), so she was particularly surprised that there would be issues.
3. She said that given the gap in the tendon she’d definitely recommend surgery. Doing a non-surgical path would be an option, but she felt the surgery had a better outcome.
4. She mentioned that there aren’t too many additional risks - maybe a slightly higher risk of DVT because I had been less mobile leading up to the surgery.

So basically, I was left without a much clearer idea of why this second rupture happened.

I went through surgery yesterday; I was scheduled for a 9:30 slot, so I had to show up at 7:30.

The process was pretty much identical to before - I had the nerve block put in in the pre-op area, and then was wheeled in for surgery.

I had more of a reaction to the anesthesia or the pain meds this time, however, and woke up more groggy and a little queasy.

When I got home, I had to take a nap. I started feeling better by late afternoon.

Unlike last time, the nerve block from surgery started wearing off around 7 pm, so I had to start on pain meds. Fortunately I have plenty left from my previous surgery.

I didn’t talk to the surgeon much about the surgery itself, but she did call me to let me know that the tear seemed to be in the same area as the previous repair. She had given my wife a little more detail while I was still waking up; Apparently she had said that she stitched up the new tear and also reinforced the old repair or something like that. I expect I’ll get a more detailed description later.

I’m also going to get a copy of my medical records - the P.A. told me that the doctor’s notes from surgery would be in there, too (and I want to know what they did differently with the anesthesia, so I can file the information away for future reference).

In any case - it’s a big relief to be back on the road to recovery.

I’m in quite a bit of discomfort still (and have some additional discomfort from the somewhat extreme position of my splint - it feels like it’s twisting my ankle into an unnatural position), but I know that by the weekend, the worst of the initial pain should be over.

Here are some pics from before the operation - you can see how nicely my wound was healing, only to be cut open again (and this time the incision will be a little longer):

You can also see the way my calf is wasting away :(

They gave me a nerve block pump again, which was pretty much a waste of time, I think. I didn’t feel much help from it, and the thing makes sleeping pretty complicated and uncomfortable.

I figured I’d show a little of how it works… Here’s what they tape to your leg:

Here’s the whole thing with the balloon filled with anesthetic and the regulator. The catheter which drips the anesthetic around the sciatic nerve is right above my knee…

Removing the tape was the hardest (and most painful) part - here I am starting to pull the catheter out…

The catheter actually slides out really easily - here it is completely removed:

That’s pretty much the update for now - Now it’s about pain management and the long road to recovery. Hopefully this second start will be a little smoother…

2 Responses to “Second Surgery - This seems familiar…”

  1. The nerve-block pump sounds really clever and elegant (if bulky) — too bad it doesn’t work well. :-(

    Good luck — this time’s a charm!!

  2. Yeah - the pump is pretty much 0 for 2 for me so far. I’m guessing that it may be very position-dependent - i.e., if it’s not in exactly the right place, it doesn’t work well.

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