Aimee Copeland, the Georgia student recovering from flesh-eating disease, is having surgery to replace swaths of bacteria-ravaged skin, her father said.
It has been six weeks since Copeland, 24, cut open her calf in a fall from a homemade zipline near the Little Tallapoosa River, inviting a deadly infection that claimed her left leg, right foot and hands. Doctors also removed skin covering her abdomen and hip, leaving a gaping wound that has been dutifully covered with sterile bandages in advance of a skin graft today.
"The area of her wound, which I saw for the first time on Sunday during a dressing change, is massive," Copeland's father, Andy Copeland, wrote in a blog post.
But the sprawling wound looked clean and red, Andy Copeland said, meaning tiny blood vessels had made their way up to the surface, ready to feed a transplanted layer of skin.
"You have to have a wound bed that's healthy and well vascularized," said Dr. J. Blair Summitt, assistant professor of plastic surgery at Vanderbilt University Medical Center in Nashville, Tenn., describing the "beefy-looking" tissue that helps seal a skin graft to a wound. "If the wound's infected, the graft won't take."
A skin graft is a thin patch of skin surgically shaved from elsewhere on the body and transplanted onto a clean, blood vessel-laden wound bed. It replaces skin lost to burns, cancer and infections, according to Summitt, who has treated at least three people with flesh-eating disease in the past nine months.
"We can get sheets between 10 and 12 thousandths of an inch thick," he said, explaining how healthy skin quickly heals from the superficial slice as the transplanted patch sets up shop in its new home. "Within two or three days, tiny little blood vessels start to grow into the graft. It's a fairly straightforward procedure."
But not all skin grafts "take," as Summitt put it. Lingering infection and insufficient blood supply can prevent transplanted skin from thriving in its new home.
"It might release from the wound bed," Summitt said, describing a failed graft as a floppy piece of pale skin. "You would have to remove the skin graft that was not accepted."
And even if the graft takes, it can cause disfiguring and disabling scars that could call for more surgery down the road.
"As it heals, the graft can cause contractures," Summitt said, describing the skin shortening that can have functional, not to mention aesthetic consequences. "But you can always revise that later on."
Andy Copeland acknowledged that his daughter's skin graft today could be one of many.
"Aimee's wound repair is a life-long process that will require ongoing attention and medical care," he wrote. "However, the surgery today will bring her one step closer to her biggest challenge yet: rehab."
Once her wound has healed, Copeland will start learning to live with prosthetics.
"This important step in Aimee's recovery process will take months to complete," Andy Copeland wrote. "But I have no doubt that she will give it the same focused effort and determination that she gave to attain an A average throughout her master's program – the same effort that, thanks to God's help, has allowed her to recover to her current condition."
Copeland's determination has also helped her through painful wound dressing changes, during which she opts for meditation over morphine.
"Although that drug effectively blocks most of the pain associated with her condition, it makes her groggy and confused and it gives her unpleasant hallucinatory episodes," Andy Copeland wrote. "Part of her master's thesis is focused on holistic pain management techniques and Aimee told me that she feels she is a traitor to her convictions when she uses pharmacological pain management. ... I know the pain was significant, but Aimee's courage is greater."